What do you think about universal health care?

[LitigatorChick]

I pay gobs and gobs of money in tax. For each of me and my husband, we are in the highest bracket, which in my province leads to 39% of my income being income tax.

I love it. I''ll never ever ever complain about taxes. It''s my part to pay for my use of the social system (including health care) and my subsidization of the system for those less fortunate or with greater needs on the system. But again, this is a bleeding heart Canadian talking.....

 

[lyra]

I asked my husband about our income taxes. He said not to forget we have federal and provincial, which takes us to 48%. So basically he''s working almost as much for the gov''t as for us.

The thing I think most every Canadian will agree on is we love hockey and we love our healthcare, flaws and all. It''s just a Canadian thing.

 

[LitigatorChick]

Lyra, move to Alberta - that Ontario (right?) income tax and PST sucks!!!

 

[gwendolyn]

I''m not sure how many other people have been able to experience both systems, but I have. I was without health insurance in the U.S. for a few years, and ended up getting treatment from a friend who works in sports medicine when I sprained my right knee, right ankle, and dislocated my right knee cap because I couldn''t afford to see a proper doctor. I am currently living in England, where I am covered by their universal health care which charges a set rate for prescription medicines (£7.10, I think it is, except for birth control which is free), whereas in the U.S. it depended upon your plan, whether you''d pay $5 or $500 for the same medicine.

It''s not a perfect system, but I vastly prefer the universal system. Yes, it sucks paying 17.5% VAT on everything, in addition to 20% income tax, but I think medical care is not something that should be dependent upon one''s income.

 

[icekid]

This is a problem that is very near and dear to my heart as a young physician. elle_chris and kbarro1 have made a lot of great points!

I do believe that we need to continue to move toward health coverage for all, but I do not want a single payer system. I absolutely do not trust the government with the health of my family. Regardless, we are so far removed from being ready right now. Also on the topic of Canada, it is important to mention that Canada is a MUCH smaller nation than the USA, with far fewer illegal immigrants. And a much higher rate of taxation!

There are so many problems with our healthcare system right now that make universal healthcare virtually impossible.

#1. Is far and away the incredible expense. And no, this has very little to do with the amount that doctors earn. In fact, physician reimbursement contributes less than 10% of our healthcare dollars. And most doctors do not make “obscene” amounts of money. Rank Amateur- $2000/hour? That is laughable. Tort reform- HUGE. This is the biggest problem facing our system. I will be sued, multiple times, and most likely for having done nothing wrong. My malpractice insurance is currently paid by my residency program, but when I finish it will fall on me and oh will it be exorbitant. In Pennsylvania, the vast majority of the residents who train leave the state when they finish because the laws are stacked against physicians and we regularly hear about multimillion dollar jury awards. This system just cannot be sustained.

Because of the very high and omnipresent risk of a law suit, we order tests that are not truly necessary. You are always worried about the 1/100,000,000 patient that will have xyz diagnosis. It’s cover your rear end medicine and we all do it. But it’s certainly not cost-effective medicine.

#2. Entitlement. Whether people want to admit it or not, universal healthcare = rationed care. People here flip their lids over waiting a couple weeks to see the doctor. Do you want to start waiting 6 months, 9 months? There are FAR fewer specialists per capita in Canada. You WILL wait to get your cataracts removed. The largest city in Canada (Toronto), trains somewhere in the neighborhood of 4 ophthalmologists per year. Philadelphia? Over 20.

Families have a “do everything” attitude when it comes to their dying family members. Medicare spends the majority of their dollars on the last couple years of life for our elderly population, and often, these are not exactly quality years. Many spend weeks in intensive care right before their death. Money well-spent? Well, I can think of better ways to spend it! In some of the countries we’re talking about with their universal healthcare, the government will NOT pay for chemotherapy or radiation for someone over a certain age, or with certain likely terminal diagnosis. Are Americans ready to accept that? Absolutely not.

If physician reimbursement continues to drop, I will probably not practice. The quality and intelligence of the average doc will plummet. It’s just not worth it for the amount of hours, stress, and liability that we must assume. With the quarter of a million dollars in school debt I have accrued and an uncertain path for medicine coming, I would likely not choose medicine if I had it to do over again. I am bright and could have chosen anything… and been making money all of this time that I’ve been studying, stressing, sleeping in a hospital. But this is my reality.

One last aside, I don’t believe that healthcare should be absolutely free for anyone. People do not value things that come without effort. I have had plenty of patients who cannot seem to afford their inexpensive medications, but wow, that crack is a pressing need. And then because they don’t take their medications, they end up in the hospital. Seriously?

 

[LAJennifer]

Date: 6/27/2008 1:28:58 PM
Author: icekid

This is a problem that is very near and dear to my heart as a young physician. elle_chris and kbarro1 have made a lot of great points!

I do believe that we need to continue to move toward health coverage for all, but I do not want a single payer system. I absolutely do not trust the government with the health of my family. Regardless, we are so far removed from being ready right now. Also on the topic of Canada, it is important to mention that Canada is a MUCH smaller nation than the USA, with far fewer illegal immigrants. And a much higher rate of taxation!

There are so many problems with our healthcare system right now that make universal healthcare virtually impossible.

#1. Is far and away the incredible expense. And no, this has very little to do with the amount that doctors earn. In fact, physician reimbursement contributes less than 10% of our healthcare dollars. And most doctors do not make “obscene” amounts of money. Rank Amateur- $2000/hour? That is laughable. Tort reform- HUGE. This is the biggest problem facing our system. I will be sued, multiple times, and most likely for having done nothing wrong. My malpractice insurance is currently paid by my residency program, but when I finish it will fall on me and oh will it be exorbitant. In Pennsylvania, the vast majority of the residents who train leave the state when they finish because the laws are stacked against physicians and we regularly hear about multimillion dollar jury awards. This system just cannot be sustained.

Because of the very high and omnipresent risk of a law suit, we order tests that are not truly necessary. You are always worried about the 1/100,000,000 patient that will have xyz diagnosis. It’s cover your rear end medicine and we all do it. But it’s certainly not cost-effective medicine.

#2. Entitlement. Whether people want to admit it or not, universal healthcare = rationed care. People here flip their lids over waiting a couple weeks to see the doctor. Do you want to start waiting 6 months, 9 months? There are FAR fewer specialists per capita in Canada. You WILL wait to get your cataracts removed. The largest city in Canada (Toronto), trains somewhere in the neighborhood of 4 ophthalmologists per year. Philadelphia? Over 20.

Families have a “do everything” attitude when it comes to their dying family members. Medicare spends the majority of their dollars on the last couple years of life for our elderly population, and often, these are not exactly quality years. Many spend weeks in intensive care right before their death. Money well-spent? Well, I can think of better ways to spend it! In some of the countries we’re talking about with their universal healthcare, the government will NOT pay for chemotherapy or radiation for someone over a certain age, or with certain likely terminal diagnosis. Are Americans ready to accept that? Absolutely not.

If physician reimbursement continues to drop, I will probably not practice. The quality and intelligence of the average doc will plummet. It’s just not worth it for the amount of hours, stress, and liability that we must assume. With the quarter of a million dollars in school debt I have accrued and an uncertain path for medicine coming, I would likely not choose medicine if I had it to do over again. I am bright and could have chosen anything… and been making money all of this time that I’ve been studying, stressing, sleeping in a hospital. But this is my reality.

One last aside, I don’t believe that healthcare should be absolutely free for anyone. People do not value things that come without effort. I have had plenty of patients who cannot seem to afford their inexpensive medications, but wow, that crack is a pressing need. And then because they don’t take their medications, they end up in the hospital. Seriously?

Excellent post, Icekid - very well said.

 

[Fancy605]

Date: 6/27/2008 10:06:39 AM
Author: gwendolyn
I am covered by their universal health care which charges a set rate for prescription medicines (£7.10, I think it is, except for birth control which is free)

Free birth controll. Now THAT's an idea I'd like to see the US explore.

 

[kbarro1]

Icekid-It is nice to hear your thoughts! Sometimes I get so heated about these issues that I am not able to say all that I want in a way that makes sense or is short enough to not lose your attention span when reading it!

Thanks for sharing an educated point of view!

 

[LitigatorChick]

Icekid, nice to hear a doc''s perspective. One point that really resonated for me was the "entitlement" bit. I think the U.S. needs to deal with the "I want it now" immediate gratification thing if there can be any movement. In Canada, we are used to it, but this would be a difficult, if not impossible change, south of the border.

 

[elle_chris]

icekid, great to hear your perspective on it.

I also agree with the not wanting a "single payer system". I didn''t mention what I do, this may be a good time. I work for a natiionwide medical equipment company that mostly services residents in skilled nursing facilities and homecare patients.
I''m the Compliance Officer. Always making sure we''re HIPAA compliant (not very exciting) so I know how Medicare/state Medicaid works.

The idea of the same people (CMS) running/ruining my own personal insurance makes me sick!! What they''re doing now with competitive bidding is leaving many providers scratching their heads.

In order to cut administrative costs ,our goverment decided to award health care contracts to providers who pretty much bid the lowest. These contracts are good for three years after which you need to bid again.

In the miamii-dade county in florida (which is one of the bidding areas in round 1 of this fiasco), they cut reimbursement rates by as much as 40%. This affects not only the companies providing various supplies to our elderly, but affects the manufactureres of those items as well.

for the "winning" bidders (if you can call it that), we now have to make this up in quantity. The better quality items that we were able to supply before will now be substituted with the cheaper version of, since it costs more to buy than medicare will pay. Patients will feel this. They may notice that an ostomy barrier for instance isn''t as comfortable, and causing irritation to their skin but we can''t do anything about that because MEDICARE cut the reimbursement rates to such a degree, that it becomes impossible to supply these people with the better equipment. This is just one example. There are so many more I can do a 20 page paper on the impact this is going to have on our elderly.

Now, is this really the goverment you want running your heathcare?

 

[KimberlyH]

Date: 6/27/2008 2:56:12 PM
Author: Fancy605

Date: 6/27/2008 10:06:39 AM
Author: gwendolyn
I am covered by their universal health care which charges a set rate for prescription medicines (£7.10, I think it is, except for birth control which is free)

Free birth controll. Now THAT's an idea I'd like to see the US explore.

Forget exploring, how about implementing immediately?

Edited to return to topic: I don't think such a system would work in this country unless doctors were allowed the option of remaining in private practice and people weren't forced to buy into the system. We would have to set up some sort of triage system to eliminate visits from people who truly don't need to see a doctor (having a cold is not a reason to head to the ER, or an MD of any kind, etc.). I have limited knowledge of the healthcare system in Massachussetts, but it seems well devised as it requires all citizens to have insurance, but the costs are subsidized by the gov't and employers who don't offer insurance when necessary. Here's an article on the subject: http://www.washingtonpost.com/wp-dyn/content/article/2006/04/04/AR2006040401937.html

 

[LaraOnline]

Date: 6/24/2008 1:46:11 PM
Author: VegasAngel
If other countries can apply it why cant we? I know it''s not free but neither is what we have now. We have long waits to be seen for doctors as well.


At the very least we have to come up with a way to make healthcare more affordable. I went from having great insurance-$10 copay, $250 maybe $500 deductible never got bills in the mail to $45 co-pay $3000 deductible & only having 85% of the bill payed. I could be slightly off with the numbers. My husbands insurance only covers him if he wants to add our daughter & me it''s outrageous. My daughter & I are on Cobra which is cheaper than my husband would pay through his employer; Cobra isnt cheap what does that tell you?


I tried to apply for private insurance for my daughter after she was born & was denied because she had acid reflux-that is unacceptable. A friend of mine was denied private insurance because she had acne, she was declined because she had PIMPLES that is insane. How many private insurances offer maternity coverage? very hard to come by.

This is the kind of stuff that scares the stuffing out of me, in relation to totally privatised health care.

Australia has been blessed with a pretty great system, but of course it is still a chronically expensive government expenditure, and waiting times are rising and rising. The general consensus is that with population changes, our really great system is generally headed for the tip.

So there is a great debate about moving more people into private health. My husband and I joined up, we had our first child in the public system, the second child in the private hospital right next door.

I paid thousands of dollars for the private birth...and although the food was better, overall I would say my nursing care was not as good.

Also, I was plagued with bill after bill for a year after giving birth.

In contrast, my public birth was absolutely free, from beginning to end...I never even SAW any paper work!

Public vs private is a debate being paid out in households around Australia, right now.

 

[Elmorton]

I work with a population of adults who often don''t have healthcare coverage because they can''t afford insurance. Some live in poverty, others are young people who can''t afford to buy their insurance from their employer.

When DH had an apendectomy earlier this year, I was stunned when I saw the cost of an overnight hospital stay and 40 min surgery - 15k. While we have insurance, we had a high deductible, so we''re paying quite a bit out of pocket. I''m thankful that we had the coverage we did and that we make enough money that we can afford to pay, but at the same time it made me realize what kind of situation many Americans are truly in.

Yes, our society is probably not ready for universal health care - but I think we need it. I think it''s really disgusting when we''re headed toward a society where only the rich can afford medical treatment.

 

[perry]

This is a very complicated issue; and it does not have a perfect answer.

I personally went almost a decade with no - or very minimal health insurance coverage. I ended that decade about $45,000 in debt (and started out with about $30,000 socked away); and a good portion of that was due to medical expenses. I also did not address other issues; and I wonder how many of my current issues really have their roots back then.

Within the US, the great US system went astray when Congress allowed the formation of HMO''s and managed health care. This took many decisions away from the patients and the doctors; and shifted a large sum of money from the individual clinics and Doctors to the managed health care system. Managed health care is actually a significant distortion on capitalism because it took away the competitive options people had (just because the companies make money does not mean it capitalism).

Prior to that people largely had heath insurance, and had to pay enough for each procedure that they knew what medical treatment cost. Yes, some people fell through the cracks; but the clinics and Dr''s always did enough free procedures to cover the basic needs (and they could afford to do that back then).

Medicare and Medicare have also not helped.

I also have a sister who lives in Canada - and I know what that system does - and what it does not.

For those who are comparing the coverage of many of the European Countries. Note that the national debt is much higher per capita than it is here in the US: Largely due to the cost of their socialized medicine programs and people are projecting a major crash in those countries someday.

So how to fix the current situation:

If it were mine to fix - here is how I would fix it in the US.

1) Repeal the law that allowed the creation of the managed health care companies.

2) Everyone is eligible for free basic coverage of routine issues. This would be basic service and services would be limited based on age and condition. Most people only need basic service for most of their life. Reality is that people with certain conditions and age die; and the government sponsored portion of basic care will not (and can not) afford to spend lots of money for limited gain.

3) Health insurance would be for major medical and specialized services beyond the very basic care. Individuals would own their own medical policy (they could pick which policy) and be able to maintain or transfer it through their life. Most of the current medical exclusions would be disallowed.

4) Patients could select their Dr and where they wanted to get treatment.

5) Have the government pay 1/2 of the cost of all Medical Student Education - and then they have to put in 5 years practice at clinics providing basic coverage services before they can go fully private.

6) Drug companies would be banned from advertising their drugs to the public.

7) Malpractice lawsuits would be severely limited. There are three kinds of issues that result in malpractice suits:

A) Routine simple mistake without major effect on a persons life. We all make mistakes. So do Dr''s and nurses. The Dr (clinic or hospital just picks up the cost of the recovery treatments and future care). Pain and suffering and future lost wages not allowed.

B) Major life altering mistake - where someone just made a mistake. Lawsuit allowed. Cost of care and future lost income allowed. Pain and suffering limited to say 1/4 Million (this could be adjusted for inflation).

C) Mistake due to gross incompetence (Dr intoxicated, Dr & Nurse distracted by their relationship, etc). Full lawsuit with unlimited pain and suffering allowed. Go get them - and go after the licenses as well.

This would eliminate 95% of lawsuits - while allowing just compensation based on what kind of mistake and why it occured.

Class action lawsuits against drug companies and medical supply providers only allowed if independent panel concludes that the company really knew of the dangers or suppressed information and that their was a factual basis for the lawsuit.

9) Allow suits against the FDA and FDA personnel for improper certification of drugs and devices (to make them do their jobs right).


Anyway, I think that would work. It would cover the relatively cheap basics for all - and allow capitalism to drive improvements and competition for the major and specialty services. Those who could afford it would still get the best care. But that is true of any system out there (and Canadians with money flock across the US border for advanced care that they cannot get - or cannot get in a timely fashion - in Canada).


Perry

 

[miraclesrule]

Perry,

I wish I could respond to your post as eloquently as you wrote, but it isn't happening so just let me say...RIGHT ON!!

I worked for a group of psychiatrists before the managed care fiasco corrupted the entire healthcare delivery system and put many good doctors out of business or at the mercy of the corporate bureaucracy that gained power over them and their practice of medicine. I eventually had my own billing and bookeeping service for a year or so as everything was transforming to "paperless" capitated plans and other HMO arrangements.

I deal with physicians, hospitals, lawyers, insurance, corporations, labor force and legislation on a daily basis. I have done so for 30 years. It provides me a unique perspective of how each operates. I have heard every argument from each of the interest groups, but as you know, they are always skewed strongly in their favor and their supporting arguments are always in the extreme. But I have also witnessed the favorable and unfavorable impact that any one of the interests can have on the success and purpose of the other interests.

You have keen insight into the problem and I am still astounded at the depth of your awareness Your very creative suggestions for a solution are completely viable and attainable.

I would tweak a few of your suggestions, just a bit, but I need to digest everything you posted. That was a very impressive post.

 

[joflier]

That''s some really good food for thought, Perry.....I especially agree with the fact that drug companies should not be allowed to saturate our media with incessent advertisements.

 

[anchor31]

Date: 6/25/2008 9:09:05 AM
Author: LitigatorChick
I''m Canadian and have lived here my entire life, so I can''t compare the 2 systems. But I do know that if I am sick, I go to the doctor and get care. My treatment is prioritized not by my pocket book, but by my need. I know the system is not perfect, but my encounters with the system in the past 2 years (having a baby and getting treatment for cervical cancer) have been excellent. And most importantly, I can focus on my health and not on my financial situation.

I''m not sure about the argument that people neglect their health if there is universal health care - the reverse isn''t true, as the States has an epedemic of obesity and other health problems.

Ditto. I have cerebral palsy and there is no way I would be healthy as I am or have the quality of life I''ve had from birth if it wasn''t for the Canadian universal health care. My mom got into surgery just a week after her breast cancer diagnosis. I was run over on my foot by a car about 3 months ago (thankfully nothing was broken), and I only waited 3 hours in the ER to get my X-rays. Maybe we were lucky, I dunno. HOWEVER, the problem we have in QC is that doctors are taking advantage of our practically free post-secondary education system to get their MDs and then going on to US to make big bucks. Less and less QC-ers have a family doctor - I don''t, and my parents just lost theirs (he''s going to FL...). I know the lack of doctors is also happening in the other provinces.

 

[Maria D]

I am an American but lived and worked in Canada (Toronto) from 1989 to 1995. I found the medical care system to be top rate. Fortunately neither I nor my family experienced any major illnesses so I can't comment on that. However, pre and post natal care for my daughter (born 1993) were excellent! And it didn't cost us a dime out of pocket.

Now that I'm back in the US, I am still grateful that (knock on wood) I and my immediate family remain healthy. I still have no direct experience with the US healthcare system and major illness but it's the little things that get me. For example, the HMO we have charges a $25 co-pay per doctor visit, an additional $25 per X-ray if it's done outside the dr's office and an additional $25 for the radiologist's interpretation of the x-ray. A lab test costs an additional $25. My primary care doctor's office is one of four clinics that belong to a major hospital. They always do x-rays at the hospital and send tests to the hospital's lab. This is a cost savings since each clinic doesn't have to replicate these services. But the insured gets penalized because three different bills get generated resulting in 3 different co-pays. So if I tweak my back or have a sore throat I might think twice about getting it checked out. Let's wait a couple of days and see if it really may be strep before I plunk down $50 for a throat culture. If I'm doing that, what are parents of multiple kids doing?

As for the shorter wait times in the US for major surgery -- what would the wait times be if everyone had access?

 

[Fancy605]

Date: 6/28/2008 2:11:48 PM
Author: KimberlyH

Edited to return to topic: I don't think such a system would work in this country unless doctors were allowed the option of remaining in private practice and people weren't forced to buy into the system.

NOW you're talking! I think this is the way to go if we do go that route. Why force people to have something they would just assume provide for themselves. I feel much the same about social security. Kimberly H for president, please.

 

[Diamond Confused]

I actually think that the blame for the high cost of insurance falls more on medical facilities than on the insurance companies themselves. Clinics, hospitals and other medical facilities scam the insurance companies. Examples:

1) insurance companies are trying to move toward havng general check-ups and general urgent care to be done by Physician's Assistants (not to be confused with medical assistants) and Nurse Practioners. They are cheaper and just as knowledgable in these areas. This would really help keep the cost of healthcare down and in turn lower the cost of insurance. The Problem: you walk into a clinic, are seen and treated by the physician assistant but the clinic bills the insurance company as if the doctor had seen the patient since it means more money for the clinic.

2) I went in to get an ear flush. THe doctor billed the insurance company as "surgical procedure" for close to $500. An ear flush is about $120.

3) My dad has follow up doctor's appointments every other month. Last year he was in the hospital for 3 months and missed two appoinments. My mom called to cancel the appointments but his doctor went ahead and charged for the two visits. My dad never went, he was hospitalized!

4) i had blood work done and I got a bill for $95. i called the clinic and let them know that they need to charge my insurance company. They did but they billed them for $140.

I think bills should be written in plain english so that patients can fully understand. They should be obligated to review and sign bills. The patients should be aware of what the insurance companies are having to pay. Clinics should give patients breakdowns of the charges as soon as the appointment is over.

I don't think there should be universal healthcare. I think regulating and improving the system we currently have is a better idea.

 

[allycat0303]

Have to weigh in as a futur Canadian doctor (in Quebec).

Anchor, (and please don''t take this the wrong way), but your comment about students taking free education and going elsewhere really hurts me. This is why it is the way it is.

In Quebec, when Doctors graduate from school, there is a system that exists that is called PREMS. This system tells doctors where they are allowed to work. Most of these places are FAR in the out skirts of Quebec , for example Chicoutimi or Saint Gilles, If you choose NOT to work there, and choose a place closer to home, you make 30% less on your salary. If you want to know why there are no family doctors in Montreal, it is because the governement penalizes family doctors 30% of their salary (every year, for as long as they work in Montreal).The idea was to try and force doctors (family doctors are mostly targeted, but ALL specialist too) to work in outlying regions.

You need to ask yourself, "why does no one want to do family medicine?" it''s because family doctors are targeted by PREMS, if you are a specialist, you are less the focus of PREMS and have a little more freedom to work where you want. Family medicine is a 2 year residency, while specialist is 5-6 years + a 2 year fellow, so we''re talking 7-8 years of residency. Family medicine is very attractive to students (especially woman who want families, and the current classes are about 70% woman, but they are scared off).

Also, EVERYONE''s education in Quebec is cheap, engineers, biologists, dentists, and NO ONE says to them "oh you have to work here 2000 miles from home." and I doubt that if you had a better offer in the US for a job, and went, you would say you were profitting of the system and leaving. I am a human being and have attachments to my family and home, just as you do, or every engineer, and dentist out there. It is not because I decided to become a doctor, that I decided to give my life over to the Quebec public.

That being said, I would say that 95% of the doctors that graduate from Quebec WANT to stay here. The governement, in MANY cases, has made it impossible for them to do so. For example last year, they trained 6 urologists, and offered 5 PREMS. They trained 6, and said there was only jobs for 5 of them. So what is that last urologist supposed to do? Stay in Quebec when he needs to pay 1500$ per month of intrest on his student loan? No, he left for the US. And this happened when there are 1.5 year wait list in Montreal for urological procedures.

My friend is a brilliant neurosurgeon who went to do a fellow in New York, he applied to work in Quebec, and the PREMS said, we can ONLY offer you a place in Chicoutimi (he is from Montreal) for $250 000 a year. He really wanted to come back to Montreal, begged the university hospitals in Montreal to hire him as a fellow for about $100 000, because his wife was in Montreal. The hospitals simply did not have the budget and said no. Meanwhile, the hospital in New York said offered him $900 000 a year, a secretary, and a research funding, as well as a lab. This is a no brainer for me, and I KNOW (not even THINK) that everyone would make the same decison he did. This does not make him someone that profited from the system.

Also, the reason you have 1.5 year wait list for operations is NOT because of lack of doctors, it''s because of lack of personnel (i.e nurses to staff the Operating rooms) you can''t perform procedures without nurses. Most surgeons in Quebec, are only schedualed to operate MAX 2 times a week. They fight like cats and dogs to get a operating slot, because most surgeons want to operate 4-5 times a week, but there are no nurses to staff the rooms.

Finally, the governement keeps saying "well the doctors are leaving, they are selfish, profitting from the system" and not enough focus is given on "why are they leaving?" They are hiding behind the pretense that *there are not enough doctors* to keep their policies out of the limelight.

Sorry if this sounds like a vent, but it disheartens me that the Quebec public is not aware of the governement''s policies. They could easily keep about 95% of their Doctors, but instead they spend 30 MILLION dollars doing RESEARCH on *where a hospital should be built* and a single brick has yet to be built. This is disgusting to me.

 

[allycat0303]

Ok now, back to universal healthcare.

I absolutely believe in it, but I think the system is far from perfect. As a principal, I agree that everyone should have the best health care available regardless of cost. I can say that generally, in Quebec, we handle the life-threatening problems very well. For example bypass-surgery, and neurological emergency, and cancer. There are delays, but nothing which compromises the health of the patient.

It is the *none life-threatening* that we have problems with. For example, knee replacement is a year surgery, as is reconstruction. Basically if you aren't going to *die* you can wait because OR time is limited and it goes to priority cases. If the MRI is for your knee, it is 1.5 year wait, if it is because we suspect a tumor then you get it the next day.

What is absolutely wonderful is this. We had a patient in heart failure that needed a pacemaker, or a pacemaker-defib. One of the options was $15 000 and the other was $35 000. We went to the patient and said, "this is risk/benefits of one, and this is risk/benefits of option 2, choose the one you feel is more compatible with how you view the end of your life." The patient does not pay, and has no idea what they cost. He picks the option he wants, and we intalled it the next morning.

The problem (in Quebec) anyways, is that it is extremely badly administered. Shocking enough that the paperwork, and administration, bureacracy of the health care costs more then ALL of the doctors, training doctors and nurses, procedures, instruments, medication dispensed in all of the hospitals in Quebec. There are MILLIONS of positions in the Quebec governement (healthcare division) that need to be cut because they are redundant and useless.

Ideally, we would have a private/public healthcare. Presently, for something like a hip replacement, the orthopedic surgeon will tell the patient "it is 1.5 year wait time" but if you can pay for operating room time in a private clinic, with 3 nurses (about $7000,) I can perform the surgery for you tomorrow. The problem is that the fear is that all of the doctors will work for the private sector and not the public sector. However, many feel that if we can give the patient the possibility of paying for use of diagnostic technics (MRI, CT scan) and OR time, but keep doctors salaries paid by the governement, this would elminate problems. Most doctors are happy to operate in ANY OR. There are doctors that go from hospital to hospital at strange hours just so they can get some OR time. This would lighten the burden on the public system, and still provide universal healthcare. The problem is that many of us have a problem with *people with money can have faster healthcare* so the main focus continues to be on making the present system work better.

 

[icekid]

ally, Thanks for taking the time to comment on the system in Canada from the inside! And what you''ve described is the type of rationing of care that I do not believe Americans are ready to accept yet.

Also, I had no idea that Canadian doctors faced so much penalty for living in more populated locations. Doctors in the States certainly make more in rural areas, but it''s really a supply/demand situation. Not something that is forced! I have definitely met some Canadian docs practicing here, for various reasons. It sounds like they really need to rethink how they treat their physicians. IMO, doctors SHOULD make a reasonable living. We work out butts off through our twenties, early thirties while everyone else is out having a good time, have barely any income until the age of 30... probably 36 or 37 for the neurosurgeon you were describing! Bah.


A situation out of my life...
I''ve been taking care of this patient with end stage COPD, absolutely no hope of recovery nor ever leaving the hospital to be frank. He has been in and out of the ICU for the past few months straight- intubated, extubated, intubated again.. over and over. The patient and his family continue to want *everything* to be done. He cannot even speak, though nods every time when I ask if he wants to be intubated again when he can''t breath. The amount of resources we waste on these types of situations is astounding- could easily pay to insure hundreds of people yearly. Our system is a mess and until Americans become less entitled, it''s going to remain a mess. There is just so much waste secondary to situations like these, in addition to all of the excessive testing that goes on b/c the patient demands it and/or cover your butt malpractice prevention. Sooooooo frustrating.

 

[icekid]

Date: 8/21/2008 5:03:37 PM
Author: Diamond Confused
I actually think that the blame for the high cost of insurance falls more on medical facilities than on the insurance companies themselves. Clinics, hospitals and other medical facilities scam the insurance companies. Examples:

1) insurance companies are trying to move toward havng general check-ups and general urgent care to be done by Physician''s Assistants (not to be confused with medical assistants) and Nurse Practioners. They are cheaper and just as knowledgable in these areas. This would really help keep the cost of healthcare down and in turn lower the cost of insurance. The Problem: you walk into a clinic, are seen and treated by the physician assistant but the clinic bills the insurance company as if the doctor had seen the patient since it means more money for the clinic.

2) I went in to get an ear flush. THe doctor billed the insurance company as ''surgical procedure'' for close to $500. An ear flush is about $120.

3) My dad has follow up doctor''s appointments every other month. Last year he was in the hospital for 3 months and missed two appoinments. My mom called to cancel the appointments but his doctor went ahead and charged for the two visits. My dad never went, he was hospitalized!

4) i had blood work done and I got a bill for $95. i called the clinic and let them know that they need to charge my insurance company. They did but they billed them for $140.

I think bills should be written in plain english so that patients can fully understand. They should be obligated to review and sign bills. The patients should be aware of what the insurance companies are having to pay. Clinics should give patients breakdowns of the charges as soon as the appointment is over.

I don''t think there should be universal healthcare. I think regulating and improving the system we currently have is a better idea.

Diamond Confused- Just a few quick comments. First, there are tons of awesome nurse practitioners and PAs. However, they will not and should not replace physicians. The difference in training is extreme.

Ear flush? Sure maybe the doctor "bills" your insurance $500, but they surely don''t pay that. It''s just how the billing system works. No matter what the doctor asks for, the insurance co isn''t going to pay more than whatever they have predetermined they will pay for said procedure. I guess at one point it was the doc''s way to try to counteract the ever decreasing compensation.

Your dad was in the hospital and missed his doc appointments? And your mom called to cancel and they still charged him.. ?! That''s ridiculous.

 

[allycat0303]

IceKid:

I think the problem in Quebec is that the population misunderstands the issues. And then they have the nerve to say "no one wants to be family doctors, everyone is leaving for the US, that's why there are no doctors in Montreal?" They won't let family doctors practice in Montreal! That's why there aren't any. We have over 300+ new residents that will finish in family med this year, and they will only allow 46 of those students to work in Montreal. All others are forced into other regions, even though they don't want to go! Easily half of ALL the graduating classes in medicine in Quebec are family practitioners and no one wants to be a family doctor? I don't even know how they can justify lying to the public like that.

If you want doctors in rural areas, you could *pay them a little more* instead of penalizing any that don't go.

I think universal heathcare is an amazing principle, but when elderly people are sleeping in stretchers in the heat in the emergency room waiting for a bed, and you spend 30 million dollars trying to *select a site for a hospital* this is a complete travesty. It takes a very tight control over finances, and honest, principaled people who will not abuse their power. Unfortunately, too often it's dishonest politicians with NO understanding of what is needed in the hospitals to make it work.

I will say, that where we are luckier is that mal practice insurance is lower then in the US. But people do not take that into account when they think of doctors salaries, but the problem is coming up. Physicians salaries in Quebec are capped, and yet the cost of malpractice insurance is rising rapidly. And the Quebec population is saying "it's not fair that obs/gyn will stop attending births if the cap is not removed"...uhmm ok, obs/gyn will now work 70 hours a week for about $80,000/year? Please, if you charge by the hour, that results in something like $22.50 per hour.Quebec mechanics make more then that per hour, so do nurses (26-35/hour), electricians (30.00/hour). Oh yeah, and everyone in Quebec gets paid maternity leave (even paternity leave), it is the law, except, oops not specialist, there's a law that we aren't paid for maternity leave. But wait, an electricien father does. And those are the conditions you get, and IF you are lucky, you get to practice where you want and not in a place 2000 miles away from your home.

So you have to give up you youth, your family, and they make it as hard as possible for you to have children, yet when they address the problems with the health care, they say "oh doctors are greedy, they are going after the money in the US?" Sometimes, the government makes me sick.

 

[saltymuffin]

Awesome post alleycat. I too am Canadian, and really beleive in public health care, but there are some SERIOUS issues with the system. I really hope we can fix the problems and not toss out the whole thing. Very few people discuss (or even acknowledge) the real issues, which is the vital first step.

 

[Anna0499]

Date: 7/4/2008 7:30:23 PM
Author: perry

So how to fix the current situation:

If it were mine to fix - here is how I would fix it in the US.

4) Patients could select their Dr and where they wanted to get treatment. Great idea, but many doctors won''t provide more expensive treatments for patients who are unable to pay, erecting a barrier to a patient''s choice.

5) Have the government pay 1/2 of the cost of all Medical Student Education - and then they have to put in 5 years practice at clinics providing basic coverage services before they can go fully private. I''m not sure about this suggestion, but I would definitely not make it for "all" medical students simply because many of them will not want to work in public clinics upon graduation. It kind of reminds me of involuntary servitude and goes against my idea of a "free market" to force a doctor to work in a certain place for a fixed amount of time. I think it would discourage people from entering the medical profession.

6) Drug companies would be banned from advertising their drugs to the public. I think the pro-active approach would be to educate consumers/future patients instead of trying to go after the drug companies. Also, health care providers are prescribing (and in some cases, pushing) these drugs, so something would need to be done about those practices as well if the advertisements are to go.

7) Malpractice lawsuits would be severely limited. There are three kinds of issues that result in malpractice suits: Medical malpractice liability insurance is actually a very, very small percentage of the growing cost of health care services. The problem with implementing an overarching theory for medical malpractice cases is that those cases are in the purview of the STATES and not the federal government and states will not be giving up that power anytime soon. Forcing over 50 jurisdictions to conform to one standard of care for medical malpractice cases is impossible. Indiana has a Medical Review Panel which reviews all medical malpractice claims and makes a determination of the negligence (or lack thereof) before the claims are actually filed; I''ve found this system to be great to reducing frivolous lawsuits. Furthermore, the majority of health care providers are GREAT and a very small percentage of them are the cause of the majority of medical malpractice suits.

A) Routine simple mistake without major effect on a persons life. We all make mistakes. So do Dr''s and nurses. The Dr (clinic or hospital just picks up the cost of the recovery treatments and future care). Pain and suffering and future lost wages not allowed. I would stick with the popular "expectation" damages where you recover any pain, suffering, lost wages, etc. that are not reasonably expected to arise out of your procedure.

B) Major life altering mistake - where someone just made a mistake. Lawsuit allowed. Cost of care and future lost income allowed. Pain and suffering limited to say 1/4 Million (this could be adjusted for inflation). I am careful to limit pain and suffering when damages are so variable from individual to individual. i.e. Pain and suffering damages for a 10 year old for the rest of his/her life would be much more than an 80 year old.

C) Mistake due to gross incompetence (Dr intoxicated, Dr & Nurse distracted by their relationship, etc). Full lawsuit with unlimited pain and suffering allowed. Go get them - and go after the licenses as well.

This would eliminate 95% of lawsuits - while allowing just compensation based on what kind of mistake and why it occured.

9) Allow suits against the FDA and FDA personnel for improper certification of drugs and devices (to make them do their jobs right). The problem with suing government entities is that you are essentially suing yourself since our taxpayer dollars are paying for the implementation of these agencies; thus why these claims are precluded. These costs would just be transferred to taxpayers. However, stricter standards would be employed (probably), so it would be a tradeoff.

Great suggestions! I hope you don''t mind the comments/suggestions. I am currently taking several Health Policy courses for my Masters/JD degrees so this topic is intriguing. We will be dissecting the presidential candidates''s (and non-candidates''s) health plans in the coming weeks, so that will be fun!

 

[fisherofmengirly]

I don''t think universal health care is the answer to the problem. But there is a problem. If you work and have insurance through your work, often times you pay out the rear and aren''t even covered for what you need (when an emergency comes up), if you work and aren''t offered medical insurance, there is no help for you unless you quit work and then apply for medicaid. It shouldn''t be like that, where if you want to get some form of coverage for medical expenses, you have to quit a job and then also need assistance with food, housing, etc.

I also wouldn''t want to be told that I needed to wait a long time for treatment that people from other countries come here to receive in a timely manner. Universal health care to that extent is not appealing at all.

 

[joflier]

I just heard a statistic on CNN that Medicare/Medicaid has a 31% fraud rate!

That''s alot of dough!

 

[Jas12]

I am a canadian and I gladly, willingly, happily pay my taxes in exchange for universal health care. I have had multiple surgeries and hospital stays for very different medical reasons and have never waited more than a month or so for a non life threatening treatment. Is UHC perfect? No, we have problems too, but i think it is worth the imperfections. Maybe some citizens take it for granted, but for the most part Canadians are hugely proud of our system and cherish it.