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View Full Version : To those outside the US with Govt. healthcare a question...



Reynard38
01-11-2016, 06:35 PM
How does it work, and are you happy with it?
We in the US hear nothing but horror stories about other nations healthcare plans. Can't ever see a doctor, month long waits, death panels etc.
So I'm asking. Say I live in your country and I've got a sinus infection and want to see the doc. How does it work, and what does it cost me?

Paul Pless
01-11-2016, 06:43 PM
We in the US hear nothing but horror stories about other nations healthcare plans. . .you will hear nothing but love for their respective systems from our foreign correspondents

Reynard38
01-11-2016, 06:46 PM
I'd considered that. I'm hoping to get some specifics. I've heard generalities about how they function. I figured the truth is somewhere in the middle.

Norman Bernstein
01-11-2016, 06:49 PM
you will hear nothing but love for their respective systems from our foreign correspondents

Not necessarily... no system is perfect, and I have indeed heard Canadians complaining about certain aspects of their health care system.

I suspect that what really matter is the overall satisfaction, which is harder to gauge. You might hear a Canadian complain, for example, about having to wait a long time to see a specialist.... but if you told him/her that some people have no access to health care because they can't afford it, they'd shudder.

S.V. Airlie
01-11-2016, 06:51 PM
M6y sister broke her leg quite badly racing boat in Italy. Amazing care, amazing food, operated on several times. Was there for 2 wks. Her bill was about 12,000. I'm not sure how good the systems are now. I was under UK's system, in 2 years, no real issues.

B_B
01-11-2016, 07:18 PM
For emergency care the Canadian system is pretty darned good. For elective procedures (hip replacements etc.) wait times can be long and frustrating. For the most part Drugs aren't covered. Mental health care absolutely sucks.

Personal experience:
- cut my finger Christmas Eve a few years back, within 20 minutes (from slicing myself open) saw a Dr. who noticed a nerve was severed. She offered to stitch it up as is, or send me off to the Big Hospital for a plastic surgeon to sew the nerve. Four hours later (he was in surgery with multiple car accident victims) I had my finger sewed up. Cost to me - I paid for parking at the second hospital, not the first, and I missed dinner.
- car accident 1,100 km's from a real hospital, within 4 hrs I was in a plane to a Big Hospital in another province. Three weeks in Intensive Care, C4C5 fusion, etc. Cost to my provincial Gov't - ~$90,000. Cost to me - nothing, except having to deal with my parents who came to 'look after' me.
- two kids, two years paid maternity leave. Cost to me - nothing except having my office at home having to deal with new borns and their mother 24/7.

Better systems in the world? Absolutely. Thankful for what we have? Absolutely.

Norman Bernstein
01-11-2016, 07:21 PM
For emergency care the Canadian system is pretty darned good. For elective procedures (hip replacements etc.) wait times can be long and frustrating. For the most part Drugs aren't covered. Mental health care absolutely sucks.

Then again, your drug prices are a LOT cheaper.


Personal experience:
- cut my finger Christmas Eve a few years back, within 20 minutes (from slicing myself open) saw a Dr. who noticed a nerve was severed. She offered to stitch it up as is, or send me off to the Big Hospital for a plastic surgeon to sew the nerve. Four hours later (he was in surgery with multiple car accident victims) I had my finger sewed up. Cost to me - I paid for parking at the second hospital, not the first, and I missed dinner.
- car accident 1,100 km's from a real hospital, within 4 hrs I was in a plane to a Big Hospital in another province. Three weeks in Intensive Care, C4C5 fusion, etc. Cost to my provincial Gov't - ~$90,000. Cost to me - nothing, except having to deal with my parents who came to 'look after' me.
- two kids, two years paid maternity leave. Cost to me - nothing except having my office at home having to deal with new borns and their mother 24/7.

Better systems in the world? Absolutely. Thankful for what we have? Absolutely.

Good report.

Is there a way to gauge what it actually costs, in terms of taxes? As a percentage of total taxes, or on a per-capita basis?

stromborg
01-11-2016, 07:40 PM
Here you go Norm, from the World Bank: http://data.worldbank.org/indicator/SH.XPD.PCAP


"Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. Data are in current U.S. dollars."

US $8553
Canada $5695

WszystekPoTrochu
01-11-2016, 08:12 PM
There's a mandatory fee subtracted from wages already by employers, children up to 18 are always insured; so do registered unemployed for a limited period of time. You can insure the whole close family without paying extra. As for now, it is around $70 a month no matter how high one's wages are. Median wage: $800/mo before taxes
Emergency handling is good, very good even. Some minor annoyances: if You'll break a leg and get to the hospital on your own, be prepared for 2-4 hour waiting period. If You're an unconcious hobo taken from under the bridge, be prepared for a full blood check and CT scan within 10 minutes.
Most hospital treatments are ok, providing You'll live long enough to get them; minor stuff may take several months or even years of waiting (usually there will be a phonecall speeding up everything, though, as multiple booking is common). This is caused by budget issues. Serious illnesses, however, will always be taken care of - the hospitals always have some spare beds left on each department. Cancer diagnostics and eventual treatment is currently unlimited by budget and thus quick. Wasn't like that few years ago. Due to waiting times and wages levels, it is very common for doctors to have a private, paid practice too. Dentistry and gynaecology are exceptions: it is very uncommon to visit a state funded practice. If one does, he/she is probably broke or at least immune to pain.
Many drugs are partly refunded. Chronic disease treatment will have refunds at 80-100% range, minor health problems 30-60%, infrequent use drugs will be not refunded. Also, price differs if it's not used as intentioned: an epilepsy drug - 90% refund - prescribed for restless legs syndrome will be refunded in 30%. Basic wheelchairs are 100% refunded, basic glasses will be refunded up to a predetermined price - only for basic, mineral uncoated glass. Naturally, that's an option only those with financial problems will want to use. I'm ok with that.
The system was reformed several times in last two decades, there were constant issues with funding, legal barriers, protests etc. Now, when hospitals have finally stopped drowing in debts from the 90s, when they are decentralized and quite autonomous, things are going well enough. Sure, fast high quality treatment is delivered outside public system; but I do not feel the need to have it A+; B is totally satisfactory.
As it comes to waiting time and general impression of efficiency, friends who emigrated to UK do not like it there even more than they didn't here. They will often come back to Poland for a treatment, using EU's common medical service deals. On the other hand, Poles will sometimes organise themselves treatment in Czech Rep. or Germany.

As far as I reckon, Greeks have to pay for everything besides monthly fees ($2 per treatment, no matter what it is - if You happen to twist an ankle like my better half did, prepare to pay $2 for consulting and $2 for an X-ray, no matter what kind of insurance and where did You get). The emergency department is decent, other departments are chronically underfunded and will have long waiting periods (several weeks to several months).

Sky Blue
01-11-2016, 08:22 PM
Chew on this one. You want that for your kids?

http://www.telegraph.co.uk/news/health/news/12079233/Third-World-dentistry-crisis-in-England.html

WszystekPoTrochu
01-11-2016, 08:33 PM
Chew on this one. You want that for your kids?
http://www.telegraph.co.uk/news/health/news/12079233/Third-World-dentistry-crisis-in-England.html

That doesn't look like funding source issue, rather educational failure

RonW
01-11-2016, 08:36 PM
There's a mandatory fee subtracted from wages already by employers, children up to 18 are always insured; so do registered unemployed for a limited period of time. You can insure the whole close family without paying extra. As for now, it is around $70 a month no matter how high one's wages are. Median wage: $800/mo before taxes

Emergency handling is good, very good even. Some minor annoyances: if You'll break a leg and get to the hospital on your own, be prepared for 2-4 hour waiting period. If You're an unconcious hobo taken from under the bridge, be prepared for a full blood check and CT scan within 10 minutes.

Most hospital treatments are ok, providing You'll live long enough to get them; minor stuff may take several months or even years of waiting (usually there will be a phonecall speeding up everything, though, as multiple booking is common). This is caused by budget issues. Serious illnesses, however, will always be taken care of - the hospitals always have some spare beds left on each department. Cancer diagnostics and eventual treatment is currently unlimited by budget and thus quick. Wasn't like that few years ago. Due to waiting times and wages levels, it is very common for doctors to have a private, paid practice too. Dentistry and gynaecology are exceptions: it is very uncommon to visit a state funded practice. If one does, he/she is probably broke or at least immune to pain.

Many drugs are partly refunded. Chronic disease treatment will have refunds at 80-100% range, minor health problems 30-60%, infrequent use drugs will be not refunded. Also, price differs if it's not used as intentioned: an epilepsy drug - 90% refund - prescribed for restless legs syndrome will be refunded in 30%. Basic wheelchairs are 100% refunded, basic glasses will be refunded up to a predetermined price - only for basic, mineral uncoated glass. Naturally, that's an option only those with financial problems will want to use. I'm ok with that.

The system was reformed several times in last two decades, there were constant issues with funding, legal barriers, protests etc. Now, when hospitals have finally stopped drowing in debts from the 90s, when they are decentralized and quite autonomous, things are going well enough. Sure, fast high quality treatment is delivered outside public system; but I do not feel the need to have it A+; B is totally satisfactory.

As it comes to waiting time and general impression of efficiency, friends who emigrated to UK do not like it there even more than they didn't here. They will often come back to Poland for a treatment, using EU's common medical service deals. On the other hand, Poles will sometimes organise themselves treatment in Czech Rep. or Germany.

As far as I reckon, Greeks have to pay for everything besides monthly fees ($2 per treatment, no matter what it is - if You happen to twist an ankle like my better half did, prepare to pay $2 for consulting and $2 for an X-ray, no matter what kind of insurance and where did You get). The emergency department is decent, other departments are chronically underfunded and will have long waiting periods (several weeks to several months).


Wonderful post, I can hardly wait till berry care is just like this and we do away with private practice doctors, maybe hillary can help us to get what they got........:D

Ain't socialism great.....down with capitalism, ehh american liberal comrades ..

Reynard38
01-11-2016, 08:40 PM
Never indicated anything about what I want for my kids. I was curious about how things worked elsewhere and I know we have a pretty diverse group here, so I asked a question. No agenda on my part.

And of course some individuals have to bring politics into the discussion.

The Bigfella
01-11-2016, 08:40 PM
Your scenario of a sinus infection.... I phone, make an appointment with the doc of my choice. Normally the same day... in fact, can't remember when it hasn't been. I walk in, see him, walk out. No cost to me other than via the tax system - which includes a 2% of taxable income levy. He bulk bills (charges the government the scheduled fee). If there's medications, it's on the PBS - Pharmaceutical Benefits Scheme. Subsidised.

Steve McMahon
01-11-2016, 08:41 PM
There are places that is difficult to have a family doctor. We have never had difficulty. For those without a family doc there are outpatient clinics. Emergency care is great, non emergency stuff can take a while.

With regards to your specific question: If you have a family doc you call and make an appointment - my experience is I get in the same day. If you go to an outpatient clinic you may wait a few hours depending on where your illness places on the triage list. The only direct cost to you will be any prescription you get. In my case I have a $5.00 copay for prescriptions with my employers plan.

Sky Blue
01-11-2016, 08:52 PM
Never indicated anything about what I want for my kids. I was curious about how things worked elsewhere and I know we have a pretty diverse group here, so I asked a question. No agenda on my part.

And of course some individuals have to bring politics into the discussion.

I should have been more clear. I wasn't trying to imply an agenda. My post was responsive to the idea that foreigners might be uniformly supportive of their systems. Also believing that to be the case, I was surprised to see the piece on how terrible the dental situation appears to be in some areas of England for children, and the OP does raise the concept of "horror stories." I'd say that is one.

Sorry if that isn't what you wanted.

The Bigfella
01-11-2016, 09:00 PM
I should have been more clear. I wasn't trying to imply an agenda. My post was responsive to the idea that foreigners might be uniformly supportive of their systems. Also believing that to be the case, I was surprised to see the piece on how terrible the dental situation appears to be in some areas of England for children, and the OP does raise the concept of "horror stories." I'd say that is one.

Sorry if that isn't what you wanted.


Ahh... dental is a different matter.

My last dental experience was in the UAE - mostly covered by the employer-provided health care. Last one for Oz... it started in Chiang Mai - 3 visits, of which 2 were specialist, root canal work. Cost US$114. Home to Oz, where work was completed. 3 more visits, including the cap. $5,000. The other downside... in Chiang Mai, the specialist was a western-trained lady with tiny hands. My Oz dentist was a big boofy bloke with mitts the size of a baseball glove.

I get nothing back from my health fund for dental work done overseas. In Oz, they paid about half the bill. My next dental appointment is in Chiang Mai... 15 hours after I arrive.

PeterSibley
01-11-2016, 09:22 PM
Your scenario of a sinus infection.... I phone, make an appointment with the doc of my choice. Normally the same day... in fact, can't remember when it hasn't been. I walk in, see him, walk out. No cost to me other than via the tax system - which includes a 2% of taxable income levy. He bulk bills (charges the government the scheduled fee). If there's medications, it's on the PBS - Pharmaceutical Benefits Scheme. Subsidised.

What he said.

A hernia....I had to wait three months then the hospital phoned and said come in, An over night operation and stay.

An amputated thumb? Emergency, straight in , surgery and rehab.

No bill at all for any of the above

hokiefan
01-11-2016, 09:30 PM
I should have been more clear. I wasn't trying to imply an agenda. My post was responsive to the idea that foreigners might be uniformly supportive of their systems. Also believing that to be the case, I was surprised to see the piece on how terrible the dental situation appears to be in some areas of England for children, and the OP does raise the concept of "horror stories." I'd say that is one.

Sorry if that isn't what you wanted.

Wasn't that many years ago that dental insurance was unheard of in the US. Certainly not common when I was a kid. And wasn't offered by the companies I worked for until about the time our kids were born. And that paid 50% tops.

goodbasil
01-11-2016, 09:30 PM
Depends which province your in. You get here and go and get yourself registered. Employers often pay it or it comes out of general taxes, except in B.C., where I am. Mine just went up on Jan.1 to $75 a month from $72. ( Big change.org protest on against it right now. ) It doesn't cover everything, like dental, glasses, cosmetic things, prescriptions, etc. etc.
Wait times, yup, just like in the states. No drive thrus. Trouble hear is that the population increases faster than the schools crank out doctors.
Back in '04 I had a pinched nerve in my arm. Was 53.5 weeks before it was fixed. A 45 minute operation, took them 25.
Back in the '60's it probably would have been done in ,3 to 5 weeks.
But it's a pretty good system, I remember all the US stations bad mouthing or system back when Obama Care was being proposed.
Some countries have better systems than we do, so I'm told. France, Switzerland....
States gets upset because its an "ism." Socialism, Communism, Terrorism, ....
Come on up. You'll like it.

B_B
01-11-2016, 09:59 PM
http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS

Is there a way to gauge what it actually costs, in terms of taxes? As a percentage of total taxes, or on a per-capita basis?


Here you go Norm, from the World Bank: http://data.worldbank.org/indicator/SH.XPD.PCAP

"Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. Data are in current U.S. dollars."

US $8553
Canada $5695
Far more revealing is Public (i.e. Government only) spending on Health Care as a % of GDP (a better indicator I think). Canada's Governments (Fed and Prov) spend 7.6% of GDP on health care. Governments in the United States spend 8.1% of GDP.

That is, expenditures in the US on health care, disregarding private/personal/insurance expenditures, is still .5% of GDP higher than in Canada.

link: http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS

slug
01-11-2016, 10:08 PM
Ive never used healthcare , so I cant comment. i have clients and friends that have used the public system and I hear no big complaints. i operate in about five different countries each year. Because of my job I am indirectly using the systems...helicopter evacuations and emergency services for instance. They work.
All These countries have public health care systems. People are generally happy . All newspaper articles concerning these countries systems indicate that they are cash strapped and ill prepared for the baby boomer arrival and the high cost of modern treatments.

be aware that not all drugs are available. The government sets price and availabily for drugs...if its too expensive or only marginally better than an established drug you may not have access to it. i ship drugs to a family in Russia. An allergy drug . The drug they need is not availble in Spain. i must import it from the UK. The health care system in Russia is generally competent but corrupt.

i have private insurance. global coverage, decent plan , 5 thousand a year, Im nearly sixty years old. My Global coverage does not give me health care in the US. i would need a separate policy.

All the Europeans that I know have two healthcare plans. Government manditory , plus a private policy. They dont trust the public system. Add In this cost when you ponder different systems.

Have I been clear. if you are economically successful you carry two policies.

AussieBarney
01-11-2016, 10:19 PM
I am an indigenous Australian. I come under a program called "Closing the gap", under this program I do not pay anything at all for my medical care or my drugs. The state pays for everything.

In Australia, we actually worry about our fellow citizens and how they are coping. Most aussies reach out and say "Brother, can I lend a hand"

In America, I would shunned as a "Welfare Bludger". Mind you, I doubt anyone would be capable of saying it to my face twice.

John Smith
01-11-2016, 10:32 PM
Let me suggest you get a copy of "Sicko" and watch it. As far as I know, the only one to question one of the facts presented in the film was the Doctor on CNN, and after some communication directly with Moore, he conceded Moore had his facts correct.

Whether or not you like Moore's odd sense of humor is hard to guess. I do, and it made the film that much more pleasant to watch.

I can also add that I know/knew people living in Canada and England. They laughed at our system.

I really wish someone with a microphone would suggest that getting rid of our employer based system would help create more, better paying jobs. Aside from covering everyone at lower cost.

xflow7
01-11-2016, 10:44 PM
I worked in Belleville, Ontario for 2.5 years at the turn of the millennium and used the Canadian healthcare system while there.

Here's my synopsis of what I observed; my own experiences and some from other expats who were there with me:

- At the time there was a concern about a shortage of family-care doctors (aka PCP's). I was able to find one without too much effort, although I was given the impression that it was easier to find one as an expat employee of a local big employer. No idea of the truth of that.
- I had an ingrown toenail that turned pretty nasty at one point. I was able to see my family-doctor on pretty short notice, he took care of it in the office, and sent me on my way. No biggie.
- I have a kidney condition so had to see a specialist there. As I recall the wait was 2 or 3 months. Having said that, I often have to wait 4-6 weeks for non-emergency specialist visits here, so it didn't seem a problem.
- I had a US friend there come down with an extremely serious, and mysterious, infection/fever that sent him to the ICU for a week or 10 days. It was touch and go at first whether he'd make it. My impression was that the quality of care was very good, but the mode of delivery is maybe a bit different. During an extended stay in a US hospital one tends to have a single physician that is point of contact throughout. It seemed like my friend was seen to by more of a cast-of-characters, although I was never aware of a lack of coordination or anything. They never did figure out what it was, but I have no particular reason to believe any given US hospital would have either.
- Another US friend had their first son there something like 8-9 weeks premature. Care was excellent and, if I'm not mistaken, they provided accommodation for my friend in Kingston while his son was in the NICU.
- I had another US colleague up there whose child suffered a severe head injury on the playground. From what I heard (this happened after I moved back) she was extremely pleased with the quality of care they received.

Dave

S/V Laura Ellen
01-11-2016, 10:56 PM
I have unfortunately had the opportunity to use the health care system in Ontario Canada due to a couple of issues. I have a doctor of my choosing (there is a shortage of GPs) and can book an appointment when needed at no cost. If it is an emergency, I can also visit a walk in clinic or the emergency room.post
When I broke my ankle, I was well taken care of. 4-5 days in the hospital, surgery, post-op care, and a couple of months of follow up care provided by OHIP (Ontario Health Insurance Plan) at no cost. The care was excellent and I didn't have to worry about paying for any of the cost, I had enough other important stuff to worry about.
When I was diagnosed with bladder cancer I again received excellent care. During the scope (out patient procedure) I was told that I likely had a very early stage of cancer, the tumour was removed at the same time as the initial diagnostic scope (based on my wishes). That day I also received a topical Chemo treatment. Later that week based on the biopsy results I was booked for another out-patient scope to remove additional areas to ensure that they got it all. I then began a series of immunotherapy (BCG treatments) to reduce the odds of a re-occurrence. I also get regular check-ups (scopes every 3-6 months) to ensure that everything is clean. All this at no cost to me and no questions about whether it was covered or not.

The health care system in Ontario is not perfect, there are waiting lists for non-emergency procedures such as hip replacements. But for time critical health issues you get the care you need, when you need it, at no cost.

Canoeyawl
01-11-2016, 11:16 PM
So, the "complaints" are laced with commentary from the far right political spectrum of the US, and they are likely to complain about a free Sunday lunch at grandmother's.

We have been hoodwinked for a long time...

Phil Y
01-12-2016, 12:17 AM
Not much to add to what's been said above about the Australian system. Most treatment is fast and free, or there may be a small gap to pay. Dental, no public cover, and private insurance only pays about half, so that can get expensive. There are waiting lists for publicly funded elective/non emergency surgery like hip replacements. The quality of care is outstanding. Funded by a 2% income tax, it's a biggish public expenditure. Can't imagine living in the US where it seems that if the poor get sick, they die. Or just stay sick.

lupussonic
01-12-2016, 03:09 AM
I had a DVT in my left arm ancilliary vena cava. For those who don't know what or where that is, it's serious. Straight in and had £20,000 worth of treatment. I'm fine now.

Emergency A+E is good, but don't turn up with a painful but non life threatening injury, particularly when the boozers are out in force, you will pace for hours.

Ambulance and paramedics here are amongst the best in the world.

Oncology, cytology, and lab based services are stretched to breaking in many areas, but still deliver admirably.

Child services are hit and miss according to area.

I personally have never had a bad experience, and I think the NHS is a credit to our nation. Wish it was better managed and supported, particularly nurses.

Junior doctors here are striking. Generally the NHS here is a much loved institution, but has been systematically torn apart by successive governments, chipped away at allowing many sectors to operate privately, and mis-managed by both parties. It's a political football unfortunately. It's imperfect, but it does function, often very well.

Standard prescription charges are about £7.00 if you pay for them. Low earners (SS, students, olds etc) don't.

Refferrals from a GP (general practitioner, the doctor at a clinic you will see first) to a specialist for "non urgent" treatment can take a while, CT / hip replacements (which are also free for low earners), etc.

If you really need it super fast, go private, but the NHS is generally brilliant in my experience, and I'm proud of it.

birlinn
01-12-2016, 03:21 AM
Prescriptions are free here in Scotland, and I don't need an appointment to see my local doc- just turn up and wait.
System usually works very well, and generally has a caring feel to it.

epoxyboy
01-12-2016, 03:34 AM
NZ very similar to Aus. There is a 0.9% levy on earnings and a $150ish annual levy on motor vehicle registration to help fund part of our system Both these levies are risk assesed, so you pay a bit more in high risk industries/older vehicles, and vice versa.
Emergency surgical care is free and immediate, even for Murican furriners, although they have cracked down on wimmins coming here to give birth and bludge off our health system. A GP visit is free for kiddies, and about $50 for an unsubsidised adult. I could ring up tomorrow morning and see one of the GP's at the local medical centre the same day. If I specifically want to see "my" GP, I might have to make an appointment a couple of days out. At this stage, it is only an annual event for me so this is never a problem.
We have the same shortcomings re elective surgery waiting lists, and access to some bleeding edge drugs and treatments that the other evil socialist public healthcare systems have, and if you need one of those new $15,000 per month biologic treatments to cure your incredibly rare gronicle cancer, you may be on you own. In contrast, my $70/week meds cost me $15...........every three months. Use of generics is common, and sometimes you have to work your way through courses of cheaper meds before they'll put you on the good stuff - assuming one of the cheaper ones didnt work.
Private insurance is increasingly common, and a surgical-only plan is a very cost effective way of mitigating the waiting list problem.
It isnt perfect, but it is pretty damn good for most of the people most of the time, and incredibly low cost for the vast majority.

Pete

Three Cedars
01-12-2016, 04:59 AM
I had a USA friend visit here in BC for several months , a military veteran who had lived in several states, experience with civilian and military hospitals in the USA , and he is married to a USA Doctor . He needed new glasses and got an eye exam while here , it was cheaper and good service he said, he chose to pay cash . Also he got his prescription drugs here , it was cheaper. - Another USA friend that was married to a Canadian was living in Idaho , eaking out a minimal living when they decided to move to BC , a year later his appendix burst and was dealt with successfully and covered by the BC medical plan . If it had happened in the USA he said they would have had to sell their house to pay for it .

My father had heart trouble , he got stents put in fairly quickly, later he needed by-pass surgery which he did wait for , it was a 4 month wait , which seemed a bit long but it was successful and he his doing fine still . The bad thing is seeing an orthopedic specialist and surgeon , just seeing one is usually 3 month+ wait , then to get into surgery is several more months . This is for knee and hip replacement that is non-emergency .

Many people don't have a family doctor and even those that do find it quicker to go to the walk-in clinic where u will see a physician within an hour or less wait .

I think the bottom line is that if you are middle class or poor and need medical care , Canada is preferred to the USA , but if you are wealthy you will be able to get to see specialists sooner . * maybe Obamacare is leveling the playing field but the corporate media is being paid not to report that , just maybe :ha

Another pal spends a lot of time in Colombia , he said if he needed a knee replacement he would get it done there . In Canada you need a referral to see a specialist , in Colombia you see the guy who will do the operation without any wait and a week later you are recovering with a chica taking care of you , but that is another story . ;)

isla
01-12-2016, 05:52 AM
I've got to say that I have nothing but admiration for the NHS..

In 1968 I fractured my femur in a motorcycle accident and spent 3 months in hospital. Good treatment and no charge, except there was a small emergency call-out fee for the ambulance.

Since 2011 I have had four major surgeries and two minor ones.

No charge for any of the above, and treatment seems to have been successful (so far). I will have ongoing reviews.

My prescription medicines are free.

My wife and I both have good NHS dentists and at 66 and 67 respectively we still have most of our own teeth (no dentures).

My wife is an American citizen but this doesn't disqualify her from receiving the same NHS treatment that UK citizens enjoy.

You qualify for a free NHS-funded sight test if:

you're aged under 16
you're aged 16, 17 or 18 and are in full-time education
you're aged 60 or over
you're registered as partially sighted (sight impaired) or blind (severely sight impaired)
you've been diagnosed with diabetes or glaucoma
you're 40 or over, and your mother, father, brother, sister, son or daughter has been diagnosed with glaucoma
you've been advised by an ophthalmologist (eye doctor) that you're at risk of glaucoma
you're a prisoner on leave from prison

All things considered I would give the NHS 10/10.

obscured by clouds
01-12-2016, 06:49 AM
In 2012 I had chest pains and was checked over by a cardiologist, who diagnosed angina and following an angiogram decided that by-pass surgery was needed, but not urgently - medication would hold things stable for a while. Waited a good few weeks - there were more urgent cases so I was shunted - but had it done in the September. Been fine since.

Neither I or any of my family have ever had a bad experience with our NHS. Yes there are elements that need to be improved - mental health issues are only now being adressed, 30 years after Thatchers 'care in the community' non-initiative; dentistry remains a major problem; many hospitals are stretched to the limit and ambulance/ paramedic response times can be too long, especially out here in the sticks, and there are not enough response teams to cover the country [my closest hospital is 40 milesa away, some have to travel 60 miles or more].

The best thing is that Wales NHS is autonomous to the English NHS so the dismantling and backdoor privatations are not happening here - and our Junior Doctors have not gone on strike.

Peerie Maa
01-12-2016, 06:59 AM
On the dental issue raised by Sky.
Some time ago the Dept of Health squeezed the NHS dentists by only paying them for only 15 minutes per patient. This is only enough for an exam but not for treatment. As a consequence most dentists reduced their NHS lists, stopped taking on new NHS patients and now sell insurance plans for their patients. Whilst these are not exorbitant not everyone can afford the outlay, and so are not covered, leaving us with a two tier system of haves and have nots.
As the Torygraph article records the Dept of Health is the cause of the problem and is in denial.
On the issue about dental hygiene and care, The NHS is relatively new. Before the NHS provided dental care few could afford any, so they neglected their teeth, and then had them all whipped out as a wedding present and had dentures made. This mind set will take a couple of generations to change, and does need a campaign of education.

Fortunately medical care is less vunerable, but still under pressure and risk from Tory ideology.

An American Doctor Experiences an NHS Emergency Room (http://www.huffingtonpost.co.uk/jennifer-gunter/nhs-emergency-room-_b_5677618.html)

WszystekPoTrochu
01-12-2016, 08:43 AM
i have private insurance. global coverage, decent plan , 5 thousand a year, Im nearly sixty years old. My Global coverage does not give me health care in the US. i would need a separate policy.

All the Europeans that I know have two healthcare plans. Government manditory , plus a private policy. They dont trust the public system. Add In this cost when you ponder different systems.

Have I been clear. if you are economically successful you carry two policies.

I do trust the public system, and never even have seriously considered getting a private policy. Now, I am not economically succesful; but those who I know that are have no such policy as well. Except for travelling outside country: we do trust the doctors, however we do not trust the bookkeepers. Not every country refunds same treatment spectrum, plus an ambulance doing an international transport is always outside public system.

You did mention a very important issue here - a typical international insurance will not include USA (and Canada is often also excluded). It seems that America suffers from medical service pricing bloat that insurance companies are not happy to cover, they'd rather offer service covering 204 or 205 out of 206 Earth's countries and a separate one regarding America only. I see no reason for the pricing bloat other than the lack of public system.

Todd D
01-12-2016, 09:08 AM
How does it work, and are you happy with it?
We in the US hear nothing but horror stories about other nations healthcare plans. Can't ever see a doctor, month long waits, death panels etc.
So I'm asking. Say I live in your country and I've got a sinus infection and want to see the doc. How does it work, and what does it cost me?


I don't currently live outside the US, but I lived in Canada for 25 years and was covered through the Canadian system. To answer your specific question, you would call your doctor and make an appointment. When you arrived at the doctor's office you would show them your health insurance card and they would record the number (unless you were already a patient there and they had your number on file, you would see the doctor and go home. You would never see a bill. If you were given a prescription you would stop off at your preferred drug store and pick it up. How the prescription would be paid for would depend on your individual situation. If you had drug coverage through your employer it would be covered by that, if not you would pay yourself at perhaps 25% of the cost here. My employer provided 100% drug coverage on a reimbursement basis.

If you had to go to the hospital you would have gone, showed them your health card, been treated and gone home. You would never see a bill. Drugs in the hospital were 100% covered.

As far as premiums and deductibles go, there were none. It was all paid through normal income taxes. My experience was in Alberta, Manitoba and New Brunswick.

As far as serious care is concerned, in 1988 my wife was hit by a car. She had a skull fracture and badly fractured leg. She was in the hospital 10 minutes after the accident where she had the usual diagnostics X-rays for the leg and a CAT scan for her head. There was some debate about having an MRI of her head, but that would have involved transport to a larger hospital 60 miles away (MRI was pretty new then and not widely available), but they decided that it wasn't worth the risk of transporting her. She was in the hospital for 4 days before her leg was operated on (bone graft, screws, etc), but only because they wanted to stabilize the head injury before operating. Overall she was in the hospital for about 10 days. After getting out of the hospital she had regular physical therapy visits. Seven months after her initial surgery she had a second surgery to remove the screws from her leg. The delay was largely to make sure her leg was fully healed before removing the screws. She saw the orthopedic surgeon every month or so during her recovery to assess her recovery. Total cost to us $15 for renting a wheel chair.

Norman Bernstein
01-12-2016, 09:24 AM
In reading over all the comments, I find it interesting that while no system is perfect, some people are more likely to appreciate the positive qualities if their countries' health care system, while others are more inclined to concentrate only on whatever negative aspects they can manage to find, in the comments.

My overall impression is the same as that of many others: nationalized health care systems are vastly superior, in MOST ways, to the way we do it in the United States.

I say 'mostly', because none of those systems are without issues worthy of some criticism... however, this is a perfect example of 'the perfect being the enemy of the good'.

For example, in a number of countries, elective surgeries that are non-emergency in nature may result in long waits for treatments. Isn't this the way it ought to be, if a system has limited resources and must be fiscally responsible? Anyone needing a hip replacement has probably spent at least a few years conscious of the fact that hip replacement was inevitable... so waiting another 3-6 months, while uncomfortable, isn't life-threatening. In the US, anyone needing a hip replacement who isn't covered by insurance doesn't have that problem, because they won't be getting a hip replacement.. they're just going to suffer.

Dental? Few people have dental coverage in the US; not many companies offer it as a benefit, and even when they do, those policies often have large co-pays, deductibles, and/or caps on annual expenditures. We heard a horror story about English dental care, but as was pointed out, dental problems are endemic in Britain, and the real solution is education... because preventative care is always cheaper than expensive dental work. I know this rather personally, having spent about $12,000, out of pocket, in the last two years on restorative dental work due to my own neglect over the years.

Just the idea of walking into an emergency room and getting treated quickly, and leaving without paying any bill, is something that ought to be commonplace, yet it's not. The last time I went to an emergency room (torn ACL in my left knee), I waited 2 hours for an x-ray, and walked out with a $500 co-pay taken from my credit card.... and the insurance company paid another $1000 or so. My treatment, aside from an x-ray: two Motrin and a pair of cheap crutches. That cost $1500?

It's pretty depressing to see people complaining about relative trivialities, when millions in the US, before the ACA, had NO coverage, and medical liabilities were the biggest reason for bankruptcy in the US.

If we want America to be 'the greatest country', as Donald Trump keeps bleating, then we ought not to be too proud to take a lesson from countries who have demonstrated how to do it better.

George Jung
01-12-2016, 09:46 AM
Always an eye-opener, reading the comments. We could do that here - but some very bloated 'ox' would require goring, maybe even dismemberment; and they won't go quietly.

IMO - the hospital system here is geared more towards emptying an individuals bank acct., than it is providing healthcare - and it really pi$$es me off. I've irritated quite a few hospital CEO's with that attitude - and they have a lot of influence. I honestly don't know how you change this system. If Single Payer would get passed - I can't imagine the blow-back you'd see from Organized Medicine.

Too Little Time
01-12-2016, 10:04 AM
Just the idea of walking into an emergency room and getting treated quickly, and leaving without paying any bill, is something that ought to be commonplace
Not to pick on the poster, but that seems to be the common thread - A free lunch.

Norman Bernstein
01-12-2016, 10:17 AM
Not to pick on the poster, but that seems to be the common thread - A free lunch.

None of those posters said anything about a free lunch. They all acknowledge that they are taxed to pay for their system.

Peerie Maa
01-12-2016, 10:37 AM
Not to pick on the poster, but that seems to be the common thread - A free lunch.


None of those posters said anything about a free lunch. They all acknowledge that they are taxed to pay for their system.

Which is the ultimate insurance system. Spread the costs as widely as possible, e.g. everyone pays in to a not for profit system. Then the cost per person is affordable and it can be free at the point of use.

Chris Coose
01-12-2016, 10:41 AM
We in the US hear nothing but horror stories about other nations healthcare plans.

False.

TomF
01-12-2016, 10:49 AM
There's variation from province to province in Canada, and even from region to region. This reflects that while there is a Canada Health Act which provides some funding transfers to Provinces in return for some specific commitments about the quality and accessibility of care (including to visiting residents of other Provinces), the Constitution puts health care under the exclusive jurisdiction of the Provinces. They do things differently, for the same raft of reasons that jurisdictions always do.

Uniformly, actual emergency care (e.g. heart attacks, car accident trauma etc.) are dealt with very swiftly and efficiently, with no financial meaningful cost to the person or their family for hospital treatment. There is variation in terms of how much or how little some drug costs may be covered when a person is discharged - some Provinces have extensive drug plans, while others leave far more room for private drug insurance. Coverage also varies from province to province re dental coverage - mostly it's not covered in Canada through our universal health programs.

Specialist care for chronic conditions (non-emergency basis) can have far longer waits than is clinically optimal - this in part reflects the actual costs to taxpayers being huge (inadequate access can be a covert way of controlling cost), and in part reflects legislative and other difficulties in meaningful authority for performance management over health provider professionals, agencies, etc. "Self-regulated professions" baulk at anyone actually regulating their behaviour, and the HR shortages within some of these professional groups means that there's often leverage which can be exerted by the clinicians against the administrators over what kinds of work they more want to spend time doing, or the types of treatment pathways or procedures they'd use to address certain conditions. These introduce variation (and hence additional cost) which would be unacceptable in private industry, because the provider groups have inappropriately become more meaningful "customers" of the systems which employ them to actually do health functions with/for patients.

Another issue with public provision which is not there with private models ... is that the public system has a mandate and requirement to provide the service not just where there is a business case, but equally where there isn't. If anything, the mandate is more stringent to provide care where it's uneconomical for private provision, because there will be no other option available for residents in those places ... while there might be a private social worker, or a pharmacist with some delegated treatment privileges, or a private physiotherapist operating in urban areas. In electoral politics, "substandard" provision of, say, very specialized neurology services in remote areas of Labrador will affect who gets elected - because if the person lived in St. John's, they'd have better access to care. Of course, the St. John's dweller doesn't have the same access to the "tertiary level" salmon fishing or etc. of the guy living in a coastal Labrador bush community, but that's seen as a "personal choice." Hmm.

On the whole, we have fairly good provision of emergency and urgent services, though mixed performance on chronic and primary care. And uniformly, we've no effective ways to make citizens accountable for their own actions affecting their health status - we charge no premiums to people whose lung cancer arose from 35 years of smoking, whose cirrhosis arose from 35 years of drinking, whose heart disease arose from 35 years of eating Doritos and moving only between couch, car, bathroom, and bed.

Our model of health care is "curative" - where the system is accountable for fixing what got broken, but the body's owner isn't accountable for what actions they may have taken to break it in the first place.

Too Little Time
01-12-2016, 01:34 PM
everyone pays in to a not for profit system.

As I have said I am in favor of free health care for the poor. Not free health care for the rich (who are included in "everyone"). Not having the poor (who are included in "everyone") pay for health care.

The rich get the free lunch, because they have the poor pick up some of the tab. That is in every country. They don't even get to opt out.

slug
01-12-2016, 01:45 PM
oh well............



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subir fotos gratis (http://postimage.org/index.php?lang=spanish)

Too Little Time
01-12-2016, 01:47 PM
None of those posters said anything about a free lunch. They all acknowledge that they are taxed to pay for their system.
They got a free lunch because others were forced into paying into the health care system.

When I was in the hospital, my wife found time to go the accounts office and ask how they wanted to be paid - credit card, check, or cash. She was willing to pay the full bill out of pocket. And it was into 6 figures.

We happened to have insurance, but that was an agreement between us and a business. There was no need to force others into paying for insurance that they did not what. I did not ask for a free lunch.

isla
01-12-2016, 01:58 PM
As I have said I am in favor of free health care for the poor. Not free health care for the rich (who are included in "everyone"). Not having the poor (who are included in "everyone") pay for health care.

The rich get the free lunch, because they have the poor pick up some of the tab. That is in every country. They don't even get to opt out.

It's a lot more complicated than that. Very low earners don't pay any NI but get the benefits. Earnings above the lower threshold have deductions made on a % basis, so high earners pay more but get the same health care. Higher earners, more than 3300 pounds per month start to pay a lower percentage rate.

epoxyboy
01-12-2016, 02:51 PM
They got a free lunch because others were forced into paying into the health care system.

When I was in the hospital, my wife found time to go the accounts office and ask how they wanted to be paid - credit card, check, or cash. She was willing to pay the full bill out of pocket. And it was into 6 figures.

We happened to have insurance, but that was an agreement between us and a business. There was no need to force others into paying for insurance that they did not what. I did not ask for a free lunch.
You may have noticed that there hasnt been a single comment bitching about the (non)exorbitant taxes/levies charged to pay for any of these nationalised health systems. That is because they only run to something like a whole one or two percent of income typically, and because we accept that having a healthy population benefits everybody in the long run - right down to things like employee absenteeism due to illness.
There are many parallels with education, where (again) the US seems to do a piss poor job relative to many other western countries. Same thing - quality education is an investment for society as a whole, and I am happy to pay for this through taxes.
There are no free lunches, and like any "insurance", I may never need it, but at a cent on the dollar, why would anyone complain?
You also seem to miss the point that while you personally were happy and able to pay a six figure sum out of pocket, relatively few people would have that sort of headroom in their personal finances.
Think about how many tax dollars you as an American are forced to pay for your almost totally non-productive bloated military. But you're OK with that, why?

Pete

SullivanB
01-12-2016, 02:54 PM
I've read more than one article suggesting that some Central and South American countries have reasonably good and inexpensive healthcare systems that are available to expatriates residing there at amazingly low cost. That surprises me, my uninformed and stereotypical impressions to blame, I'm sure, but it sounds to good to be true. Can anyone offer insight?

Peerie Maa
01-12-2016, 02:55 PM
As I have said I am in favor of free health care for the poor. Not free health care for the rich (who are included in "everyone"). Not having the poor (who are included in "everyone") pay for health care.

The rich get the free lunch, because they have the poor pick up some of the tab. That is in every country. They don't even get to opt out.


It's a lot more complicated than that. Very low earners don't pay any NI but get the benefits. Earnings above the lower threshold have deductions made on a % basis, so high earners pay more but get the same health care. Higher earners, more than 3300 pounds per month start to pay a lower percentage rate.

Absolutely. I was simplifying out of deference for some of the forumites who read this ;)

The problem with the rich pay for everything and the poor get it for free is where do you draw the line? There is no justice in a system that penalises you if you earn £1 above the threshold and lose the benefit.

SullivanB
01-12-2016, 02:58 PM
You may have noticed that there hasnt been a single comment bitching about the (non)exorbitant taxes/levies charged to pay for any of these nationalised health systems. That is because they only run to something like a whole one or two percent of income typically, and because we accept that having a healthy population benefits everybody in the long run - right down to things like employee absenteeism due to illness.
There are many parallels with education, where (again) the US seems to do a piss poor job relative to many other western countries. Same thing - quality education is an investment for society as a whole, and I am happy to pay for this through taxes.
There are no free lunches, and like any "insurance", I may never need it, but at a cent on the dollar, why would anyone complain?
You also seem to miss the point that while you personally were happy and able to pay a six figure sum out of pocket, relatively few people would have that sort of headroom in their personal finances.
Think about how many tax dollars you as an American are forced to pay for your almost totally non-productive bloated military. But you're OK with that, why?

Pete

Well, if Ronald Reagan were alive, we know he'd be badmouthing the hell out of all those evil, socialist programs. And somehow it'd all be Bernie Sanders' fault.

Peerie Maa
01-12-2016, 03:13 PM
I've read more than one article suggesting that some Central and South American countries have reasonably good and inexpensive healthcare systems that are available to expatriates residing there at amazingly low cost. That surprises me, my uninformed and stereotypical impressions to blame, I'm sure, but it sounds to good to be true. Can anyone offer insight?

I dunno about other countries but Cuba is a world leader in some aspects of health care.

Sky Blue
01-12-2016, 03:16 PM
Well, if Ronald Reagan were alive, we know he'd be badmouthing the hell out of all those evil, socialist programs.


He wouldn't be the only one.

http://news.sky.com/story/1621243/hospital-ends-call-for-striking-doctors-to-return

WX
01-12-2016, 03:19 PM
I dunno about other countries but Cuba is a world leader in some aspects of health care.

I've heard that before. Quite impressive actually.

John Meachen
01-12-2016, 03:51 PM
Always an eye-opener, reading the comments. We could do that here - but some very bloated 'ox' would require goring, maybe even dismemberment; and they won't go quietly. IMO - the hospital system here is geared more towards emptying an individuals bank acct., than it is providing healthcare - and it really pi$$es me off. I've irritated quite a few hospital CEO's with that attitude - and they have a lot of influence. I honestly don't know how you change this system. If Single Payer would get passed - I can't imagine the blow-back you'd see from Organized Medicine. Interesting comments George,given your inside knowledge of the system.Without wanting to get into politics at all I have to wonder whether there is a pressure to run all conceivable tests on a patient given that they both increase the revenue stream and deflect ambulance chasing lawyers who might be seeking a negligence suit if any stone is left unturned.Such a scenario can only increase the cost for whoever might be landed with the bill.

George Jung
01-12-2016, 03:54 PM
Maybe, esp. for an employed physician - or one with ownership in a lab, say, or a CT/MRI scanner. Hate to be cynical, but....

I've tried 'employment' - didn't care for it. I make less as an independent; it's worth every penny.

Too Little Time
01-12-2016, 03:56 PM
The problem with the rich pay for everything and the poor get it for free is where do you draw the line? There is no justice in a system that penalizes you if you earn £1 above the threshold and lose the benefit.

This is so true about my medicare premiums. My wife worked so hard to keep our income (some line on the tax return) below $170K this past year. $1 over would cost us several thousand dollars additional in premiums in each of the next 2 years. But there are a lot of situations where this happens.

But it is easy to avoid such situations in crafting the revenue producing laws. But it is very difficult to avoid taxing the poor - however they are defined.

The Bigfella
01-12-2016, 04:00 PM
I dunno about other countries but Cuba is a world leader in some aspects of health care.


I've heard that before. Quite impressive actually.

I ran across Cuban doctors in Timor-Leste. Good to see them out helping, but on exploring a bit further, it seems they are ill-equipped to deal with the issues. Treating TB without adequate drugs and support programs to ensure proper follow-up is worse than doing nothing.

TomF
01-12-2016, 04:05 PM
oh well............
If you think you're poking a sharp stick in my eye by observing inefficiency in Canada's various health systems, you ought to feel disappointed. You'll not see me claiming that our systems are anything like as efficient as they ought to be, or sustainable. That wasn't the question, though.

A big piece of my work over the past number of years has been trying to address some of those inefficiencies, and I could talk your ear off. I won't.

Too Little Time
01-12-2016, 04:16 PM
You may have noticed that there hasnt been a single comment bitching about the (non)exorbitant taxes/levies charged to pay for any of these nationalised health systems. That is because they only run to something like a whole one or two percent of income typically, and because we accept that having a healthy population benefits everybody in the long run - right down to things like employee absenteeism due to illness.
There are many parallels with education, where (again) the US seems to do a piss poor job relative to many other western countries. Same thing - quality education is an investment for society as a whole, and I am happy to pay for this through taxes.
There are no free lunches, and like any "insurance", I may never need it, but at a cent on the dollar, why would anyone complain?
You also seem to miss the point that while you personally were happy and able to pay a six figure sum out of pocket, relatively few people would have that sort of headroom in their personal finances.
Think about how many tax dollars you as an American are forced to pay for your almost totally non-productive bloated military. But you're OK with that, why?

Pete
A quick google search reveals that 10% of the New Zealand GDP is health care cost. So your 1 or 2 percent of income is perhaps an underestimate. If not, there is your free lunch. But that is not your point. Your point is that you think you personally benefit from the program. And you are willing to pay for the benefit you get. That benefit includes having a healthy population. I don't know of anyone who objects to that.

I am objecting to the cost structure.

I don't know about people complaining about the cost of health care in "these nationalized health care systems." I do know that in the past many people in the US complained about their high premiums. Those were the rich people. Their premiums fell. I do know currently many people are complaining about co-pays, deductibles, and out of network charges. Those seem to be poor people. Al lot of their free care vanished.

I expect people stop complaining once they realize they are stuck with the short stick and no one cares.

Peerie Maa
01-12-2016, 04:23 PM
A quick google search reveals that 10% of the New Zealand GDP is health care cost. So your 1 or 2 percent of income is perhaps an underestimate. If not, there is your free lunch. But that is not your point. Your point is that you think you personally benefit from the program. And you are willing to pay for the benefit you get. That benefit includes having a healthy population. I don't know of anyone who objects to that.

I am objecting to the cost structure.

I don't know about people complaining about the cost of health care in "these nationalized health care systems." I do know that in the past many people in the US complained about their high premiums. Those were the rich people. Their premiums fell. I do know currently many people are complaining about co-pays, deductibles, and out of network charges. Those seem to be poor people. Al lot of their free care vanished.

I expect people stop complaining once they realize they are stuck with the short stick and no one cares.

These are the spread of the figures
http://www.kingsfund.org.uk/sites/files/kf/media/web-2_v5.jpg

Source: OECD Health Data 2015 (http://www.oecd.org/health/health-systems/health-data.htm)
The UK spends a smaller proportion of its GDP on health care than countries such as Portugal, France and the Netherlands. It spends a larger proportion than countries such as Spain, Finland and Ireland.
This data includes private spending on health care, which in the United Kingdom is only 1.5 per cent.

The funding is partly contributions by those with an income, and a share contributed by their employers.

Curtism
01-12-2016, 04:37 PM
Don't wait around on me to stop complaining, even though I rarely waste time grousing about the for-profit system here. I'm "relatively low(fixed)income and my premiums are a full 10% of my income. Should I ever actually need medical attention there's a $4500 deductible and if it was something even slightly serious, the insurance would only cover 73% of the remaining costs, leaving me on the hook for 27% I'll likely never be able to pay. Had I not qualified for a subsidy insurance would only cover 70% of the bills.

Without the subsidies my premiums would have been a full 30% of my income, before deductibles. I guess, from what I hear here, that I should be grateful for access to "affordable" health care, eh? Somehow I'm instead left feeling like I am merely contributing to the delinquency of a bloated system.

SullivanB
01-12-2016, 05:03 PM
Interesting comments George,given your inside knowledge of the system.Without wanting to get into politics at all I have to wonder whether there is a pressure to run all conceivable tests on a patient given that they both increase the revenue stream and deflect ambulance chasing lawyers who might be seeking a negligence suit if any stone is left unturned.Such a scenario can only increase the cost for whoever might be landed with the bill.

The best thing a physician can do to avoid malpractice litigation is to practice good medicine. Ordering measures beyond those dictated by good and accepted standards of practice will unnecessarily run up costs but it's not going to protect a practitioner from those "ambulance chasing lawyers". The high costs involved are just another excuse resorted to when a party is seeking so called tort reform.

As for universal single payor, the benefits coming from the negotiating clout with such a large and powerful system could and should have very serious impact on lowering costs. I say "could and should" because it won't work if our politicians hamstring the system as, for example, was done by the Bush administration in prohibiting the system from negotiating costs with for pharmaceuticals. If that wasn't a crime, it should have been.

Peerie Maa
01-12-2016, 05:22 PM
Don't wait around on me to stop complaining, even though I rarely waste time grousing about the for-profit system here. I'm "relatively low(fixed)income and my premiums are a full 10% of my income. Should I ever actually need medical attention there's a $4500 deductible and if it was something even slightly serious, the insurance would only cover 73% of the remaining costs, leaving me on the hook for 27% I'll likely never be able to pay. Had I not qualified for a subsidy insurance would only cover 70% of the bills.

Without the subsidies my premiums would have been a full 30% of my income, before deductibles. I guess, from what I hear here, that I should be grateful for access to "affordable" health care, eh? Somehow I'm instead left feeling like I am merely contributing to the delinquency of a bloated system.

Before I retired this year I paid just under 10% to cover both my contribution to the NHS (free at point of use) and my state pension. My employer also made a similar contribution. There was a nominal fixed charge for any medication at the pharmacy of £8.40. Now that I am retired that comes for free as well.

WszystekPoTrochu
01-12-2016, 05:39 PM
Stop whining about that free lunch nonsense, there is no free lunch. Vast majority has public healthcare based on standarised, instutional insurance fees. You're not paying, You're not insured, You get to pay a nice big sum for treatment.

Peter Malcolm Jardine
01-12-2016, 06:54 PM
How does it work, and are you happy with it?
We in the US hear nothing but horror stories about other nations healthcare plans. Can't ever see a doctor, month long waits, death panels etc.
So I'm asking. Say I live in your country and I've got a sinus infection and want to see the doc. How does it work, and what does it cost me?


Of course you hear horror stories.... it is in the best interest of your for-profit healthcare system to denigrate all the socialized systems in the world that are better than the USA healthcare system.... about 35 of them to be factual. Some of the socialized health care systems in the world are fantastically better than the US, and the real statistic is how these systems provide for everyone, while spending substantially less per patient than the US does. However, as long as you have total morons yipping about socialism in the health care system, your country is doomed to provide third world medical care to about a third of the US population. So it goes.

Canadian healthcare has it's glitches, but generally it's quite good, and accessible to everyone. It's better than the US system, and the WHO says so. I don't lose a minutes sleep about my access to health care. It's just not on my radar..... just like not worrying about being shot. I don't worry about that either.

Too Little Time
01-14-2016, 12:47 PM
the real statistic is how these systems provide for everyone, while spending substantially less per patient than the US does.

History is the most important part of the story. For the US to spend as little as the next most expensive country, costs would have to be cut by about 40%. Costs are not going to be cut. That is a fact. So US health care will always be more expensive than that in other countries, if only because we started with a higher cost.

It is not socialism that is the problem. It is history. Perhaps you have a way to change that.

Peerie Maa
01-14-2016, 12:49 PM
History is the most important part of the story. For the US to spend as little as the next most expensive country, costs would have to be cut by about 40%. Costs are not going to be cut. That is a fact. So US health care will always be more expensive than that in other countries, if only because we started with a higher cost.

It is not socialism that is the problem. It is history. Perhaps you have a way to change that.

Legislate that the Health Insurance Companies convert to "not for profit". Same for the hospitals.

AndyG
01-14-2016, 12:59 PM
free NHS-funded sight test...

I thought all NHS sight tests in Scotland were free?

Andy

isla
01-14-2016, 01:46 PM
I thought all NHS sight tests in Scotland were free?

Andy

Yes you're right, good point. Because my mother had glaucoma I became eligible a long time ago, and my wife has near perfect eyesight, so only had her first test after she was 60. So I haven't really thought much about other people's eligibility in Scotland.

P.I. Stazzer-Newt
01-14-2016, 01:48 PM
Also free in Tesco!

Sometimes in specsavers.

George Jung
01-14-2016, 03:12 PM
Legislate that the Health Insurance Companies convert to "not for profit". Same for the hospitals.


Hehehe.... right. You do know that some of the most profitable 'systems' in this country are not for profit, right?

"I don't think that word means what you think it means'' might've been inspired by that.

Norman Bernstein
01-14-2016, 03:15 PM
Don't wait around on me to stop complaining, even though I rarely waste time grousing about the for-profit system here. I'm "relatively low(fixed)income and my premiums are a full 10% of my income. Should I ever actually need medical attention there's a $4500 deductible and if it was something even slightly serious, the insurance would only cover 73% of the remaining costs, leaving me on the hook for 27% I'll likely never be able to pay. Had I not qualified for a subsidy insurance would only cover 70% of the bills.

Without the subsidies my premiums would have been a full 30% of my income, before deductibles. I guess, from what I hear here, that I should be grateful for access to "affordable" health care, eh? Somehow I'm instead left feeling like I am merely contributing to the delinquency of a bloated system.

It's not hard to point out the shortfalls of the ACA. Obamacare certainly isn't perfect.

The question you have to ask yourself, however, is how the system PRIOR to Obamacare was. In what way were you better off, before Obamacare?

Admittedly, for people whose income is so low that the deductible would either bankrupt them, or seriously compromise their finances, Obamacare doesn't have a solution. But, then again, the existing system didn't have a solution, either, and didn't cover ordinary well care, things like annual checkups (without any copay), AT ALL. I think the architects of Obamacare can point out that regular medical care, in the form of annual checkups, etc., saves enormous amounts of money; for example, people with incipient diabetes can be identified, and medications can be prescribed, BEFORE the heart attacks, nerve damage, blindness, and amputations set in... and those things are hugely expensive.

You want a vastly BETTER system than Obamacare? Then you want nationalized universal single payer.... and the right wing politicians are what prevent that from happening.

Peerie Maa
01-14-2016, 03:17 PM
Hehehe.... right. You do know that some of the most profitable 'systems' in this country are not for profit, right?

"I don't think that word means what you think it means'' might've been inspired by that.

Sorry, I was speaking English, not Americlish. ;)

By definition, the word nonprofit means "not conducted or maintained for the purpose of making a profit" Merriam-Webster Dictionary (http://beta.merriam-webster.com/dictionary/nonprofit). A nonprofit organization or organisation (see spelling differences (https://en.wikipedia.org/wiki/British_and_American_spelling_differences)) (NPO, also known as a non-business entity[1] (https://en.wikipedia.org/wiki/Nonprofit_organization#cite_note-1)) is an organization (https://en.wikipedia.org/wiki/Organization) that uses its surplus revenues (https://en.wikipedia.org/wiki/Economic_surplus) to further achieve its purpose or mission, rather than distributing its surplus income to the organization's shareholders (or equivalents) as profit or dividends (https://en.wikipedia.org/wiki/Dividend).

Peter Malcolm Jardine
01-14-2016, 03:20 PM
The single largest reason for personal bankruptcy in the United States: health care bills.

I don't believe that someone should lose everything they own and have worked for because a family member got sick. YMMV.

Too Little Time
01-14-2016, 03:30 PM
Legislate that the Health Insurance Companies convert to "not for profit". Same for the hospitals.
40% cut in expenses means that most medical care employees will take rather large pay cuts. Many hospitals are not-for-profit. You might not understand how insurance companies work. They negotiate patient charges down. The government is a bit better, but not enough to cover the 40% that needs to be cut.

You should disregard the comments about not-for-profits being profitable.



The single largest reason for personal bankruptcy in the United States: health care bills.

I don't believe that someone should lose everything they own and have worked for because a family member got sick. YMMV.

So many people tell that lie. Yes, most people who have debts and seek bankruptcy have some medical debt. But that debt is seldom enough on its own to merit bankruptcy. The chief cause of bankruptcy is poor money management.

Peerie Maa
01-14-2016, 03:43 PM
40% cut in expenses means that most medical care employees will take rather large pay cuts. Many hospitals are not-for-profit. You might not understand how insurance companies work. They negotiate patient charges down. The government is a bit better, but not enough to cover the 40% that needs to be cut.

You should disregard the comments about not-for-profits being profitable.




So many people tell that lie. Yes, most people who have debts and seek bankruptcy have some medical debt. But that debt is seldom enough on its own to merit bankruptcy. The chief cause of bankruptcy is poor money management.

Insurance companies pay shareholders, and probably have to pay for working capital. By losing the shareholders cut there is an instant reduction in costs in the system. That would be a big step. There may be other changes needed, but that is an obvious start, obvious in that you don't need to know all of the ins and outs or hidden costs to identify it. I am not proposing cut in wages, just in dividends to shareholders etc.

George Jung
01-14-2016, 03:48 PM
40% cut in expenses means that most medical care employees will take rather large pay cuts. Many hospitals are not-for-profit. You might not understand how insurance companies work. They negotiate patient charges down. The government is a bit better, but not enough to cover the 40% that needs to be cut.

You should disregard the comments about not-for-profits being profitable.




So many people tell that lie. Yes, most people who have debts and seek bankruptcy have some medical debt. But that debt is seldom enough on its own to merit bankruptcy. The chief cause of bankruptcy is poor money management.


Missed it.... by this much!

Why am I not surprised?

Too Little Time
01-14-2016, 04:44 PM
Insurance companies pay shareholders, and probably have to pay for working capital. By losing the shareholders cut there is an instant reduction in costs in the system. That would be a big step. There may be other changes needed, but that is an obvious start, obvious in that you don't need to know all of the ins and outs or hidden costs to identify it. I am not proposing cut in wages, just in dividends to shareholders etc.
A google search indicates that in good years the profits of insurers is 7% of revenue. Other areas of health care have lower percentages. I will be kind an give you a 7% cut in expenses by converting all of the health care system to not-for-profit. You now have 33% more to cut.

It is not just hard to cut 40%. It is impossible.

slug
01-14-2016, 04:53 PM
Seven percent sounds reasonable .

whats wrong with business making profit ?

Peerie Maa
01-14-2016, 04:55 PM
A google search indicates that in good years the profits of insurers is 7% of revenue. Other areas of health care have lower percentages. I will be kind an give you a 7% cut in expenses by converting all of the health care system to not-for-profit. You now have 33% more to cut.

It is not just hard to cut 40%. It is impossible.

OK, as you know more about your system than I, why are you being shafted? Where does the money go?

Peerie Maa
01-14-2016, 04:55 PM
Seven percent sounds reasonable .

whats wrong with business making profit ?

Do you believe that it is moral to profit out of fellow citizens misfortune?

slug
01-14-2016, 04:58 PM
Sure...buisness is buisness.

if they provide a quality service they should be rewarded.

Norman Bernstein
01-14-2016, 04:58 PM
Seven percent sounds reasonable .

whats wrong with business making profit ?

Recalculate, after figuring in the executive salaries and bonuses.

I recall the story of Maxim Semiconductor, whose president consumed 95% of the entire corporate profit, via his salary and bonus.

Peerie Maa
01-14-2016, 05:02 PM
Sure...buisness is buisness.

if they provide a quality service they should be rewarded.

Sheesh, when did a shareholder mop up sick or clean a bed pan? What service does an insurance company shareholder provide?

slug
01-14-2016, 05:02 PM
Well..you obvoiusly know all about it.

i dont...i just pay the bills.

perhaps its best if corporations make no profit .

everything would be cheaper !

Clarkey
01-14-2016, 05:05 PM
You are being screwed by a healthcare cartel, sewn up by the insurance companies. Drugs and medical devices typically fetch 5 to 10x more on the US market and you are happy to pay it. The rest of the world is not - and doesn't.

Peerie Maa
01-14-2016, 05:08 PM
Well..you obvoiusly know all about it.
I know this:
http://www.kingsfund.org.uk/sites/files/kf/media/web-2_v5.jpg

i dont...i just pay the bills. yep, dumb and happy.

Keith Wilson
01-14-2016, 05:20 PM
The rest of the civilized world manages to pay about half of that we pay in the US, so it is obviously not impossible. Everybody else is already doing it. But TLT is correct about history; this is a problem that's been building for a long time.

Time sequence:

http://s.wsj.net/public/resources/images/OB-YH203_HEALTH_G_20130723135724.jpg

Too Little Time
01-14-2016, 07:05 PM
OK, as you know more about your system than I, why are you being shafted? Where does the money go?
Aside from history I don't know.

Perhaps individuals in the US feel more entitled. I am told some people think that being in the middle class means having health insurance at work. I think that many think Cadillac health insurance or at least Cadillac health care is a entitlement of the rich. Maybe people are too distant from paying for their care so they don't care about cost.

I never thought I was shafted. In the few years I had health insurance, I and my wife had high deductible plans that seemed to be properly priced. And the care seemed to be properly priced.

Canoeyawl
01-14-2016, 09:24 PM
Well... I wonder what happened in the 1980's that kicked this off?

Hint - Bedtime for Bonzo

The "privatization" of public hospitals. Which lead to consolidation, closures, bankruptcies, and Profits for Cronies.



The rest of the civilized world manages to pay about half of that we pay in the US, so it is obviously not impossible. Everybody else is already doing it. But TLT is correct about history; this is a problem that's been building for a long time.

Time sequence:

http://s.wsj.net/public/resources/images/OB-YH203_HEALTH_G_20130723135724.jpg

Boater14
01-14-2016, 10:50 PM
Hey, new guy, we asked this question years ago. They love their healthcare and think we are uncivilized nuts. I asked if the Canadians really watched their kids die waiting in line like the reeps say and the Canadians looked on us with pity. This is just old cold soup.

John How
01-14-2016, 11:44 PM
I think a single payer system could be in our best interest, the only thing I worry about is that we'd completely screw it up. I'm voting for Bernie in hopes of finding out. Either way I just signed up for my Medicare plans due to start before the election. Though not exactly single payer, I hope it helps cut expenses some.

WX
01-15-2016, 02:12 AM
It boils down to what we have pretty much works for everyone, what you have works really well for those that can afford it and possibly not at all for those that can't. Which would you prefer, a system that works for all Americans or one that just benefits the well off?

Peerie Maa
01-15-2016, 03:56 AM
Aside from history I don't know.

Perhaps individuals in the US feel more entitled. I am told some people think that being in the middle class means having health insurance at work. I think that many think Cadillac health insurance or at least Cadillac health care is a entitlement of the rich. Maybe people are too distant from paying for their care so they don't care about cost.

I never thought I was shafted. In the few years I had health insurance, I and my wife had high deductible plans that seemed to be properly priced. And the care seemed to be properly priced.


Before I retired this year I paid just under 10% to cover both my contribution to the NHS (free at point of use) and my state pension. My employer also made a similar contribution. There was a nominal fixed charge for any medication at the pharmacy of £8.40. Now that I am retired that comes for free as well.If you are paying less than 10% of your income you are comparable with the average UK worker. Any more plus any co-pays charged, and you are not doing so well.

slug
01-15-2016, 06:14 AM
You may have noticed that there hasnt been a single comment bitching about the (non)exorbitant taxes/levies charged to pay for any of these nationalised health systems. That is because they only run to something like a whole one or two percent of income typically, and because we accept that having a healthy population benefits everybody in the long run - right down to things like employee absenteeism due to illness.
There are many parallels with education, where (again) the US seems to do a piss poor job relative to many other western countries. Same thing - quality education is an investment for society as a whole, and I am happy to pay for this through taxes.
There are no free lunches, and like any "insurance", I may never need it, but at a cent on the dollar, why would anyone complain?
You also seem to miss the point that while you personally were happy and able to pay a six figure sum out of pocket, relatively few people would have that sort of headroom in their personal finances.
Think about how many tax dollars you as an American are forced to pay for your almost totally non-productive bloated military. But you're OK with that, why?

Pete


Long lifespan baby boomers and thier high cost old age related treatments, modern wonder drugs, large scale immigration and high levels of unemployment will bring single payer, socialized medicine to its knees.

It is happening now.

Peerie Maa
01-15-2016, 06:23 AM
Long lifespan baby boomers and thier high cost old age related treatments, modern wonder drugs, large scale immigration and high levels of unemployment will bring single payer, socialized medicine to its knees.

It is happening now.

If it becomes unaffordable (less than 10% of my income) for socialized medicine, the US insurance based system will be truly crippling.

The only problem with European socialised medicine is that no one likes paying more even if it is only more peanuts, and right wing governments always want to reduce government revenues putting more pressure on the system.

PeterSibley
01-15-2016, 06:36 AM
Long lifespan baby boomers and thier high cost old age related treatments, modern wonder drugs, large scale immigration and high levels of unemployment will bring single payer, socialized medicine to its knees.

It is happening now.

Actually the US system is a perfect illustration of how bad a system can get if the private profit motive is the primary driver. It may seem incomprehensible but there are countries around the world that operate for the good of all their population, not just to make a profit for the already rich.

slug
01-15-2016, 06:47 AM
25 percent unemployemt in Spain, 50 percent youth unemployment.

who is paying for healthcare.

Any reduction in Gdp growth, any increase in unemployment will hammer social programs.

To overcome reduced revenue Europe will be forced to raise tax , at the wrong time in the economic cycle , in order to pay for all its promises. greece.

this will not be allowed to happen...the social system will be scrapped first.

Peerie Maa
01-15-2016, 06:52 AM
25 percent unemployemt in Spain, 50 percent youth unemployment.

who is paying for healthcare.

Any reduction in Gdp growth, any increase in unemployment will hammer social programs.

To overcome reduced revenue Europe will be forced to raise tax , at the wrong time in the economic cycle , in order to pay for all its promises. greece.

this will not be allowed to happen...the social system will be scrapped first.

So Spain needs to fix its unemployment. Taking healthcare away from any of the population is a dumb suggestion worthy of Social Darwinism.

Peter Malcolm Jardine
01-15-2016, 09:04 AM
So many people tell that lie. Yes, most people who have debts and seek bankruptcy have some medical debt. But that debt is seldom enough on its own to merit bankruptcy. The chief cause of bankruptcy is poor money management.



Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid. Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings. This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=6162089), Elizabeth Warren of Harvard Law School (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=6162087), and Deborah Thorne, a sociology professor at Ohio University (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=4141584), found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.


...

slug
01-15-2016, 09:28 AM
...


Medical emergencies dont cause bankrupty, lack of personal savings and excess debt do.

Keith Wilson
01-15-2016, 09:29 AM
May I point out again that Europe is spending roughly half of what the US spends for health care? 'Europe can't afford it' is completely at odds with the numbers. The US has the least-efficient health care system of any developed country; vastly more expensive for no better results.

Norman Bernstein
01-15-2016, 09:30 AM
Medical emergencies dont cause bankrupty, lack of personal savings and excess debt do.

Interesting.... so, if someone needs a liver transplant, and it costs $100,000, and insurance won't cover it, or they have no insurance, it's THEIR fault for not having a spare $100,000 lying around?

TomF
01-15-2016, 09:31 AM
Medical emergencies dont cause bankrupty, lack of personal savings and excess debt do.Really. So one shouldn't schedule a significant cancer discovery or car accident to occur during one's 20s?

varadero
01-15-2016, 09:45 AM
In my world the health care is excellent, if you wish, you can buy premium care for about €50 per month extra, this covers a 50% discount on elective care, fast track to avoid waiting lists, dental basic, and hotel type suites for recovery. This €50 per moth is also tax deductable as it relieves the state care, which I must say is better than what is availiable in the UK. What is lacking is the nursing care and hotel services, which they expect your family to provide for you. Cannot complain really. If you are employed the company must provite an annual check up which declares if you are fit to do the job you do, also if you are injured at work, your work insurance covers that cost, not the state.

Too Little Time
01-15-2016, 10:31 AM
This newest, nationwide study, conducted before the start of the current recession by Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=6162089), Elizabeth Warren of Harvard Law School (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=6162087), and Deborah Thorne, a sociology professor at Ohio University (http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?capId=4141584), found that the filers were for the most part solidly middle class before medical disaster hit. Two-thirds owned their home and three-fifths had gone to college.
...
I don't deny that there are studies that draw that conclusion. But there are people who have examined the data in those studies and made other conclusions.

I tend to believe the other studies. I say that because so many people exhibit poor money management - credit card debt, college loan debt, lack of retirement savings, lack of emergency savings.

Commenting on the study you quoted. At that time family coverage for a high deductible health care insurance - $10K deductible with $20 million max benefit, cost under $12K/year. Easily manageable by a "solidly middle class" family. People choose to spend their money the way they want. They make poor decisions. And it easier to place blame on medical bills rather than poor money management decisions.

slug
01-15-2016, 10:34 AM
The average american is a paycheck away from bankrupcy.

If you are American, get sick, lose your job...youre toast.

Even if you had the best health insurance plan invented.

Too Little Time
01-15-2016, 10:48 AM
Really. So one shouldn't schedule a significant cancer discovery or car accident to occur during one's 20s?
Currently anyone can get health insurance that will handle their situation. They don't want it. They buy the policy with the lowest premium. Then they complain about the network size, the deductibles, the co-pays. If you want people to have health care, give it to them. Oh. wait.The ACA took that type of care away from a lot of people - tens of billions of uncompensated medical expense paid to care givers for people who could not afford health care.

One of the papers had an article on the "high coat" of medical care.

There was a fellow with health insurance. His policy was grandfathered in. He was informed by his insurer that he was about to exceed his lifetime drug benefit and that he should change to a ACA compliant policy. Identical except for the lifetime benefit cap. He insisted on keeping his policy.

He now pays $140K/year for his drugs. And he complains about the cost.

People are stupid. He would not change policies to save over $100K/year.


People are really stupid. It is not the medical costs of the car accident that causes bankruptcy. The medical people will give a discount and wait for their money. It is the 6 months out of work that causes the bankruptcy. (That is what health insurance used to pay for - lost wages.)

Peerie Maa
01-15-2016, 10:55 AM
Currently anyone can get health insurance that will handle their situation. They don't want it. They buy the policy with the lowest premium. Then they complain about the network size, the deductibles, the co-pays. If you want people to have health care, give it to them. Oh. wait.The ACA took that type of care away from a lot of people - tens of billions of uncompensated medical expense paid to care givers for people who could not afford health care.

One of the papers had an article on the "high coat" of medical care.

There was a fellow with health insurance. His policy was grandfathered in. He was informed by his insurer that he was about to exceed his lifetime drug benefit and that he should change to a ACA compliant policy. Identical except for the lifetime benefit cap. He insisted on keeping his policy.

He now pays $140K/year for his drugs. And he complains about the cost.

People are stupid. He would not change policies to save over $100K/year.


People are really stupid. It is not the medical costs of the car accident that causes bankruptcy. The medical people will give a discount and wait for their money. It is the 6 months out of work that causes the bankruptcy. (That is what health insurance used to pay for - lost wages.)

Yep, people are stupid. In the USA that means that they can loose their home or their life savings. In the UK they have to find other ways to do that as ill health does not attract the same financial risk.

Too Little Time
01-15-2016, 11:45 AM
Yep, people are stupid. In the USA that means that they can loose their home or their life savings. In the UK they have to find other ways to do that as ill health does not attract the same financial risk.
If we gave everyone in the US free health care, people would still loose their home and life savings due to health issues.

I think both homes and retirement accounts are protected from bankruptcy.

Yesterday I read the smart guys wait until they are sick than they get their insurance. Those not quite so smart don't pay the premiums for the last 3 months of the year. Lovely loop holes.

Peerie Maa
01-15-2016, 11:54 AM
If we gave everyone in the US free health care, people would still loose their home and life savings due to health issues.



That is a different argument though, being too ill/disabled to work can be a difficult problem even in a welfare state.

It is not a valid argument for not fixing your heal care issues though.

Norman Bernstein
01-15-2016, 11:57 AM
I think both homes and retirement accounts are protected from bankruptcy.

No, they aren't.

Too Little Time
01-15-2016, 12:08 PM
That is a different argument though, being too ill/disabled to work can be a difficult problem even in a welfare state.

It is not a valid argument for not fixing your heal care issues though.

Who said anything about being disabled? Requiring medical care usually implies taking some time off from work.

Peerie Maa
01-15-2016, 12:11 PM
Who said anything about being disabled? Requiring medical care usually implies taking some time off from work.

That is less of a problem for us, as our system pays sick pay, either negotiated as a part of your contract of employment, or as Statutory Sick Pay, not generous but an income.

Too Little Time
01-15-2016, 12:14 PM
No, they aren't.
Perhaps you could do a google search before being typing.

You walked away from your Joe Biden thread before you explained how Joe Biden who was well above the median (assets) of Congressmen was poor relative to the DC politicians. It seems the explanation there is the same as here. You typed and hoped no one would note your lie.

You might take some guidance from your tag line.

Norman Bernstein
01-15-2016, 12:24 PM
Perhaps you could do a google search before being typing.

You walked away from your Joe Biden thread before you explained how Joe Biden who was well above the median (assets) of Congressmen was poor relative to the DC politicians. It seems the explanation there is the same as here. You typed and hoped no one would note your lie.

You might take some guidance from your tag line.

*lol* You're going to demand an answer from ME?

When you tell all of us about how you're getting $50K to $100K in tax free income as a result of Obama's budget deal, maybe I'd give you an answer.

You've got a pot-kettle problem going on here. Play with the children... I'll stick to the adults.

B_B
01-15-2016, 12:25 PM
Medical emergencies dont cause bankrupty, lack of personal savings and excess debt do.


http://big.assets.huffingtonpost.com/2013_09_HealthCareCosts3.png

From the graph can you and Too Little draw any conclusions
Or is it all poor management and financial collusion
To bankrupt oneself is despair and disillusion?

Too Little Time
01-15-2016, 12:29 PM
That is less of a problem for us, as our system pays sick pay, either negotiated as a part of your contract of employment, or as Statutory Sick Pay, not generous but an income.

While I am not a very good businessman, I do recognize a missed opportunity. The UK could have come over here a decade ago, built hospitals, hired employees and provided the same care here as they did at home and made a huge profit - or given us a lower cost system.

You might notice that we have had the ACA for several years. People are still talking about the same issues as before the ACA. People are offering up proposals that will re-solve those issues. I am sure that your health care system works for you.

Peerie Maa
01-15-2016, 12:33 PM
While I am not a very good businessman, I do recognize a missed opportunity. The UK could have come over here a decade ago, built hospitals, hired employees and provided the same care here as they did at home and made a huge profit - or given us a lower cost system.

You might notice that we have had the ACA for several years. People are still talking about the same issues as before the ACA. People are offering up proposals that will re-solve those issues. I am sure that your health care system works for you.

Whilst ACA is a step in the right direction, I think that it only addresses one end of the problem. Hopefully you will be able to close the costs gap as well.

john welsford
01-15-2016, 01:27 PM
To get this thread back on track, I'll post about a friend of mine who had an accident mid last year.
He's in his late 50s, a bit overweight and not very fit, went out to help a friend move some heavy stuff around in his workshop and did some damage to his back.
A week later, in lots of pain crawled into his family doctors rooms, (well, on his wifes shoulder as he could not walk unaided) and was sent off to hospital for an MRI scan.
Severe damage in his lower back.
Sent home, District Nurse ( travelling nurse who cares for people in their own homes while awaiting for or recovering from treatment) until he was taken back to hospital a couple of weeks later, had the operation to fuse three discs and repair damage around the sciatic nerve junction, 8 days in hospital, back home with the DN calling each day, physiotherapy specialist called three times a week for a month to get him mobile again, wheelchair then crutches and raised toilet device supplied.
He's back on his feet.

No insurance, same as most people here in NZ, much of our medical system is taxpayer funded. All drugs supplied, several MRI scans, in home care, hospital stay, the operation, the transport in an ambulance, therapy, all covered by the system.

In addition to that the system paid him 80% of his wage until he was able to return to work.

Cost to him, NZ$40 for the initial, heavily subsidised visit to the family doctor.

Note, the proportion of our income that is taken in taxes is not a lot different to that prevailing in most parts of the USA.

John Welsford, who cant understand why people cant see that its a much better system both for society in general and for the individual than having to pay an insurance company who's main objective is to make a profit from your illness or accident.

Norman Bernstein
01-15-2016, 01:41 PM
To get this thread back on track, I'll post about a friend of mine who had an accident mid last year.
He's in his late 50s, a bit overweight and not very fit, went out to help a friend move some heavy stuff around in his workshop and did some damage to his back.
A week later, in lots of pain crawled into his family doctors rooms, (well, on his wifes shoulder as he could not walk unaided) and was sent off to hospital for an MRI scan.
Severe damage in his lower back.
Sent home, District Nurse ( travelling nurse who cares for people in their own homes while awaiting for or recovering from treatment) until he was taken back to hospital a couple of weeks later, had the operation to fuse three discs and repair damage around the sciatic nerve junction, 8 days in hospital, back home with the DN calling each day, physiotherapy specialist called three times a week for a month to get him mobile again, wheelchair then crutches and raised toilet device supplied.
He's back on his feet.

No insurance, same as most people here in NZ, much of our medical system is taxpayer funded. All drugs supplied, several MRI scans, in home care, hospital stay, the operation, the transport in an ambulance, therapy, all covered by the system.

In addition to that the system paid him 80% of his wage until he was able to return to work.

Cost to him, NZ$40 for the initial, heavily subsidised visit to the family doctor.

Note, the proportion of our income that is taken in taxes is not a lot different to that prevailing in most parts of the USA.

John Welsford, who cant understand why people cant see that its a much better system both for society in general and for the individual than having to pay an insurance company who's main objective is to make a profit from your illness or accident.

The critics, John, will probably argue that he didn't deserve the care, because, after all, he was unfit and overweight.

The problem with that perspective is that trying to gauge the individual contribution to medical expenses, based on physical condition, would be a fascist nightmare. Many of us here are in our 60's, and I'm sure we have some sexagenarians who run marathons, and others who are committed couch potatoes. ALL of us need health care, at some point or another, and trying to decide who does or doesn't deserve health care would be insane.

We DO, to a very limited extent (here in the US) try to provide a little bit of incentive for people to have good health; discounts for gym memberships, programs on healthy eating, etc. However, there will always be some variability to our individual health, and even the worst fast-food-eating couch potato needs health care. Often times, the need is independent of fitness. If our couch potato develops colon cancer, and has a family history of the same, should we automatically blame it on his poor personal fitness?

I am reminded of Jim Fixx, a renowned marathon runner, seemingly the most fit individual imaginable.... who dropped dead of a heart attack at age 52.... as well as some grotesquely obese people I know, living well into their 90's.

slug
01-15-2016, 01:46 PM
The critics remind you that the single payer system is unsustainable.

it will be scrapped or much reduced.

even in New Zealand.

http://www.stuff.co.nz/the-press/news/10055088/Solving-the-looming-health-crisis

Norman Bernstein
01-15-2016, 01:51 PM
The critics remind you that the single payer system is unsustainable.

it will be scrapped or much reduced.

even in New Zealand.

http://www.stuff.co.nz/the-press/news/10055088/Solving-the-looming-health-crisis

This would be informative, if it weren't for the fact that the Kiwis are complaining about the costs, in a system where the costs are just a fraction of what they are in the US.

If you think this is alarming, then what do you think about our own health care costs? Forget about blaming it on Obamacare... health care costs have been escalating at well over the rate of inflation, for DECADES.

Peerie Maa
01-15-2016, 01:52 PM
Funny that your year and a half year old link does not say that the NZ system will be scrapped.

john welsford
01-15-2016, 03:42 PM
That was one wildly pessimistic persons perspective, whats actually happened is that there is that vote health has been increased. Its not perfect, and there are areas where more funding would help, but I have every confidence that if I had fallen off a ladder and broken a leg while painting the topsides of my ship this week I'd have been treated and rehabilitated as well as anywhere in the world. And no I dont pay any insurance premiums.
Pretty much every developed country in the world has a taxpayer funded health system, they vary as to just how its worked, but they work.

John Welsford


been
The critics remind you that the single payer system is unsustainable.

it will be scrapped or much reduced.

even in New Zealand.

http://www.stuff.co.nz/the-press/news/10055088/Solving-the-looming-health-crisis

john welsford
01-15-2016, 03:51 PM
The critics, John, will probably argue that he didn't deserve the care, because, after all, he was unfit and overweight.

The problem with that perspective is that trying to gauge the individual contribution to medical expenses, based on physical condition, would be a fascist nightmare. Many of us here are in our 60's, and I'm sure we have some sexagenarians who run marathons, and others who are committed couch potatoes. ALL of us need health care, at some point or another, and trying to decide who does or doesn't deserve health care would be insane.

We DO, to a very limited extent (here in the US) try to provide a little bit of incentive for people to have good health; discounts for gym memberships, programs on healthy eating, etc. However, there will always be some variability to our individual health, and even the worst fast-food-eating couch potato needs health care. Often times, the need is independent of fitness. If our couch potato develops colon cancer, and has a family history of the same, should we automatically blame it on his poor personal fitness?

I am reminded of Jim Fixx, a renowned marathon runner, seemingly the most fit individual imaginable.... who dropped dead of a heart attack at age 52.... as well as some grotesquely obese people I know, living well into their 90's.


Yes, I agree that there should be incentives to care for ones body as well as possible. But those incentives are really already there in terms of improved enjoyment of life.
There is a lot of work being done here by the health system to encourage people to maintain a reasonable standard of fitness, to eat a good diet ( a big problem among certain population groups here) and to generally look after themselves. But the health system is "no fault" to use an insurance phrase, and no matter what state you've let yourself get into, they'll give you whatever you need to get you back up and running ( walking in some cases) again.

As I've said before, its not a perfect system, but it works pretty well for most people. Two years ago my Wife had a new knee joint, cost? Zero, waiting time, about 10 months, good job, she and I walked a very challenging mountain trail a couple of months ago.

An interesting comment from an American woman I know who has lived here for a couple of decades, she said "Kiwis dont seem to mind paying their taxes, I think that its because they feel that they get good value from them".

John Welsford

Norman Bernstein
01-15-2016, 03:58 PM
http://c.o0bg.com/rf/image_960w/Boston/2011-2020/2015/12/17/BostonGlobe.com/EditorialOpinion/Images/1218toonwasserman.jpg

WszystekPoTrochu
01-15-2016, 09:16 PM
Man, I've read some posts here with slight disbelief.

Is it only my impression or do we have social Darwinists speaking here?

Keith Wilson
01-15-2016, 10:46 PM
Is it only my impression or do we have social Darwinists speaking here?Indeed. One would think they'd be extinct by now.

Howard Sharp
01-15-2016, 11:58 PM
I've had decades of experience in both the UK and the US, and I would say that the biggest benefit of the NHS is the freedom from worry - worry about being bullied by insurance companies, being unable to pay etc. In fact if someone asked me why fewer people in Europe go to church I would say it's because there's a more general freedom from worry about existential threats. That is a freedom the majority of Americans don't have.
The quality of service is comparable in both countries.
I would also say that my one bad experience in medicine has been here in the States when I was unnecessarily treated for a non-existent problem. It wasn't fun.

Peerie Maa
01-16-2016, 04:50 AM
Man, I've read some posts here with slight disbelief.

Is it only my impression or do we have social Darwinists speaking here?


Indeed. One would think they'd be extinct by now.

No. The force is strong in . . . .

slug
01-16-2016, 05:25 AM
Darwin always wins.

Read it and weep.


http://info.worldbank.org/etools/docs/library/139494/S&P_AgingSocietiesSovereignRatings.pdf



http://s9.postimg.org/3oxofn58f/image.jpg (http://postimg.org/image/kpgkobi9n/full/)
sube fotos (http://postimage.org/index.php?lang=spanish)

Peerie Maa
01-16-2016, 05:57 AM
Sod all to do with Darwin, and you are fool if you think that it does.

PeterSibley
01-16-2016, 06:00 AM
Please include Australia in your table, we have a debt to GDP ratio of IIRC, 22% and free health care.



Darwin always wins.

Read it and weep.


http://info.worldbank.org/etools/docs/library/139494/S&P_AgingSocietiesSovereignRatings.pdf



http://s9.postimg.org/3oxofn58f/image.jpg (http://postimg.org/image/kpgkobi9n/full/)
sube fotos (http://postimage.org/index.php?lang=spanish)

slug
01-16-2016, 06:02 AM
http://s1.postimg.org/erglveklb/image.jpg (http://postimg.org/image/peaf0tsqj/full/)
imag (http://postimage.org/index.php?lang=spanish)

PeterSibley
01-16-2016, 06:03 AM
Strangely enough it's something most are very happy to see governments spend money on.... it beats the hell out of invading other countries.

slug
01-16-2016, 06:10 AM
In Canada public health is projected to consume nearly 100 percent of total revenue

Yup....no schools, no police, and no wars because there will be no government

Peerie Maa
01-16-2016, 06:15 AM
I am ignoring that unattributed screen shot posted out of context.

I will say that creating Health trusts was a brilliant cynical strategy. It nominally allowed good managers to be recruited to run the hospitals. What a lot of trusts got was young ex supermarket managers, not head office experienced managers, but small town branch managers. What the strategy allows is the Dept of Health to under-fund the trusts when setting the budget and then blame the trust for failing.

If we currently spend a little over 8% of GDP we can afford to spend more.

PeterSibley
01-16-2016, 06:19 AM
In Canada public health is projected to consume nearly 100 percent of total revenue

Yup....no schools, no police, and no wars because there will be no government

Your straw man argument seems a little thin.:D

The lack of wars might be nice though.

slug
01-16-2016, 07:59 AM
Yah...looking bad...real bad.

darwin is coming your way.

http://s12.postimg.org/45gl6y6r1/image.jpg (http://postimg.org/image/gk3d79y95/full/)
imagen jpg (http://postimage.org/index.php?lang=spanish)

TomF
01-16-2016, 08:06 AM
In Canada public health is projected to consume nearly 100 percent of total revenue

Yup....no schools, no police, and no wars because there will be no governmentAhem. 5 years ago, the growth rate in seniors medically discharged from hospitals but with nowhere to go was supposed to be consuming about 60% of hospital beds by now too. And it's not.

There was a serious public health conference in London at the start of the 20th century concerned about projections that horse manure would be piled yards deep in London streets if projections continued.

slug, you need to think a wee bit.

Peerie Maa
01-16-2016, 10:13 AM
This is the document that the FT reported on: https://www.nao.org.uk/press-releases/sustainability-and-financial-performance-of-acute-hospital-trusts/


Despite recent efforts to work together, interventions from the Department and its arm’s-length bodies risk creating perceived or actual competing priorities for trusts. One area where advice to trusts could have created actual or perceived conflicts is on safe staffing. The Department’s interventions to reduce trusts’ spending on agency nursing staff, for example, came at a time when acute trusts needed to recruit more nurses to meet safe staffing guidelines, and when the vacancy rate for permanent nursing staff was high

Full reports available here: https://www.nao.org.uk/report/sustainability-and-financial-performance-of-acute-hospital-trusts/

JimD
01-16-2016, 10:39 AM
In Canada public health is projected to consume nearly 100 percent of total revenue

Yup....no schools, no police, and no wars because there will be no government
Dang, I wish that had happened when I was a kid and not an old man. I wouldn't have had to go to school.

slug
01-16-2016, 10:44 AM
The Canadian system is good at boosting US GDP.

tens of thousands of Candians must travel south to recieve required medical care.

Nothing wrong with that .

john welsford
01-16-2016, 11:23 AM
Interesting, New Zealand has a developing industry of "Medical Tourism" based on Americans coming here for the likes of hip and knee replacements. No they dont get it on our taxpayer funded system but its a great deal cheaper than their own medical system.
So far its not attracting much attention, but a friend who is a senior nurse in a small specialist surgical unit near me tells me that they have half a dozen or so Americans a month through their orthopedic ward.
Good for us. Another way for the country to make a buck.

John Welsford



The Canadian system is good at boosting US GDP.

tens of thousands of Candians must travel south to recieve required medical care.

Nothing wrong with that .

George Jung
01-16-2016, 11:55 AM
Medical tourism is - or should be - an eye-opener. The cost disparity should be criminal. For orthopedic surgery, an 'orthotic' - say, a new, artificial hip - may cost $20,000 or more - while a very similar, non-protected device sold in Europe may be $500. There are some excellent meds from Gilead pharmaceuticals, for treatment of Hepatitis C. Cost for the drugs (not the administration - just the drugs) is $75 - 85,000 for a 12 week course. Same cost in India, where they didn't grant patent protection is..... $350 dollars. And Gilead is still making money.

Offers a bit of insight into the 'mind' of our RWW's, their defense of this crap. Should've gone into circus work; masterful contortionists (not to mention debaters)

Too Little Time
01-16-2016, 11:56 AM
As I've said before, its not a perfect system, but it works pretty well for most people. Two years ago my Wife had a new knee joint, cost? Zero, waiting time, about 10 months, good job, she and I walked a very challenging mountain trail a couple of months ago.
The lowest cost for a knee replacement in the US is about $20K. I just say that to show how much people health care your government is willing to give to those in need. But the point of my comment is to ask a question.

Do individuals get a card for free food and shelter? And I don't mean a limited amount of food stamps or access to a food kitchen. Nor do I mean temporary shelter in large rooms shared with many others. I mean does the country provide all the food a typical person would eat? Does the country provide the typical shelter - a house, in whatever location desired to all? Why not socialize both food and shelter to the same extent?


I see the presumption that people would rather have free health care - no matter how good, than good food, or good shelter is a problem with programs like this.

George Jung
01-16-2016, 12:03 PM
A knee for $20,000? I don't think so! Provide a link, if you would. Ensure it's 'total cost', and not for the orthotic alone.

My nephew had a recent appendectomy - which I diagnosed, which his mother (an RN) ran herd on - and 'total cost' was $22,000. For a damned appe. Unconscionable.

Keith Wilson
01-16-2016, 01:29 PM
Slug, you are completely ignoring the fact that the US spends twice as much per capita on medical care as the average of the developed world. This is a percent of GDP; it's rather more in dollars. If there's any rich country on the planet that can't afford their health care system, it's the US.

slug
01-16-2016, 01:38 PM
Cut american gun related injuries and american obesity then the numbers will look better.

Dont fantasize about any social health program unless you can show me proje tions that indicate it is sustainable.

Norman Bernstein
01-16-2016, 02:36 PM
.
Dont fantasize about any social health program unless you can show me proje tions that indicate it is sustainable.

In the context of health care, 'sustainability' simply refers to what the country is willing to pay for. Systems which are cheaper, are more sustainable.... and the rest of the world offers examples of cheaper systems, mostly with better results and outcomes.

We know what it was like before the ACA: millions of Americans without health coverage, something like $88 billion in taxes to pay for uncompensated care given out in emergency rooms, constant price escalations well in excess of the rate of inflation. Since the enemies of the ACA have not suggested a replacement plan, then this is precisely what we would be going back to, if Obamacare was repealed.

Ya think things were better, back then?

What COULD we do? Well, we COULD give up on stupid, foolish partisan pride and idealist ideology, and acknowledge that other countries have better solutions that produce better results and end up costing less....

....but until the people who simply REFUSE to acknowledge this finally get the message.... it's hopeless.

Peerie Maa
01-16-2016, 03:05 PM
Dont fantasize about any social health program unless you can show me proje tions that indicate it is sustainable.

Which do you think is more sustainable? A system that costs over 16% of GDP, or one that costs under 11%?

Too Little Time
01-16-2016, 03:08 PM
A knee for $20,000? I don't think so! Provide a link, if you would. Ensure it's 'total cost', and not for the orthotic alone.

There is this wonderful thing called the internet. You type in "google" followed by "cost of knee replacement". (I can even get the same information using my cell phone and talking to google.) It answers all questions.

Yea. I just checked. The internet is still there. It still gives the same answer.

But my point was why not give everyone free access to food and shelter?

Norman Bernstein
01-16-2016, 03:15 PM
From the hallowed 'Internet':


The average hospital charge for a total knee replacement (TKR) in the United States is $49,500. A partial knee replacement (PKR) typically costs about 10 to 20 percent less than a TKR. The main reason is that the operation requires a shorter hospital stay. For example: an average of 2.3 days, compared to 3.4 days. Keep in mind that hospital charges donít reflect the amount you pay out of pocket. Out-of-pocket costs are explained in more depth below.

The cost of a knee replacement can vary substantially, even within the same geographical area. The final hospital charge depends on many factors, including:


number of days spent in the hospital: This will vary depending on the type of knee replacement you have (total, partial, or bilateral).
type of implant and surgical approach: This includes the material the implant is made of and if any customized surgical instruments or specialized computer technology used.
pre-existing conditions: You might require extra care in the hospital or additional precautions during surgery.
length of time spent in the operating room
unanticipated care or equipment required: Complications you experience during your hospital stay might call for it.


Where Are These Charges Coming From?
The bill for a total knee replacement has both pre- and post-surgery costs as well as the price of the surgery itself, with charges including:

pre-surgery doctor visits and lab work
the surgery and the time you spend in the operating room, including charges for the anesthesia and other tools used
your hospital stay
post-surgery doctor visits
physical therapy


You should expect multiple bills following a knee replacement surgery, including:


hospital bills
bills for all treatments you received from the surgeon while in the hospital
other tasks and procedures performed by the operating room staff (This includes work done by the anesthesiologist, surgical assistants, physical therapists, and others.)



Inpatient Charges

Inpatient charges are charges that occur while youíre in the hospital. Inpatient charges from the surgeon and other healthcare providers may add an average of roughly $7,500 to the basic hospital charge for the procedure. This brings the average total charges for a TKR in the United States closer to $57,000.

Too Little Time
01-16-2016, 03:16 PM
something like $88 billion in taxes to pay for uncompensated care

Since the enemies of the ACA have not suggested a replacement plan, then this is precisely what we would be going back to, if Obamacare was repealed.

There are no enemies of the ACA. There are people who think that taking $88 billion in heath care away from the poor and making them pay premiums, deductibles, and co-pays is. Then there are people who believe that making the young and healthy pay for the care of the old and sick is wrong.

The interesting part is those who wanted change to the ACA now want change from the ACA. More change = More opportunity to charge the poor more.

Too Little Time
01-16-2016, 03:25 PM
From the hallowed 'Internet':
You seem to be unable to read. The average is not the minimum.


You might read the Blue Cross Blue Shield study on cost variations. There is a table near the front. Reading the captions will get you where I went.

isla
01-16-2016, 03:26 PM
But my point was why not give everyone free access to food and shelter?

Is it just me, or is that a really dumb question? The point is, our health care is not free. We pay an insurance premium (National Insurance) throughout our working lives which covers healthcare costs. Unlike food and shelter, which are everyday needs, healthcare for most people is only an occasional need. Some people go for years without needing a doctor, in the same way that your house doesn't get hit by lightning every day. Of course, we could just pay 90% of our wages to government and have them cover food and housing :rolleyes:

Norman Bernstein
01-16-2016, 03:30 PM
Is it just me, or is that a really dumb question? .

It's not just you :)

isla
01-16-2016, 03:32 PM
It's not just you :)

Phew! :D

Peerie Maa
01-16-2016, 03:35 PM
Is it just me, or is that a really dumb question?

Some things are just beneath contempt.

TomF
01-16-2016, 03:51 PM
The Canadian system is good at boosting US GDP.

tens of thousands of Candians must travel south to recieve required medical care.

Nothing wrong with that .Some do, to get specific services which are not available (a friend's son is getting a particular brain surgery technique in Texas... which is only offered in 3 locations in North America). Others wish to get service faster than the Canadian system would provide, for things like hip or knee replacement surgery.

Nobody waits for actual emergency services.

BTW, I'd love to see your cites. Bear in mind that I have worked in the Canadian health system for quite some time, in a position to prepare and see the statistical analyses of such things presented to Ministers.

Peerie Maa
01-16-2016, 04:00 PM
BTW, I'd love to see your cites.

Slug does not do cites, Slug uses screen-shots so that you cannot check the validity of his sources.

Too Little Time
01-16-2016, 04:04 PM
Is it just me, or is that a really dumb question? The point is, our health care is not free. We pay an insurance premium (National Insurance) throughout our working lives which covers healthcare costs. Unlike food and shelter, which are everyday needs, healthcare for most people is only an occasional need. Some people go for years without needing a doctor, in the same way that your house doesn't get hit by lightning every day. Of course, we could just pay 90% of our wages to government and have them cover food and housing :rolleyes:
Perhaps the internet does not understand how Scotland works.

NHS Scotland (https://en.wikipedia.org/wiki/NHS_Scotland), that provides healthcare to all permanent residents that is free at the point of need and paid for from general taxation.
That is the way we finance our schools here. And the schools are free. So the question is not really dumb. (you pay a tax not a premium.)

I personally think food and shelter is more important than health care. I don't understand your objection to free food and shelter. Perhaps you see yourself profiting from your healthcare system but not profiting from a similar system for food or shelter..

PeterSibley
01-16-2016, 04:05 PM
There are no enemies of the ACA. There are people who think that taking $88 billion in heath care away from the poor and making them pay premiums, deductibles, and co-pays is. Then there are people who believe that making the young and healthy pay for the care of the old and sick is wrong.

The interesting part is those who wanted change to the ACA now want change from the ACA. More change = More opportunity to charge the poor more.

One thing I've learned about the US and capitalist perspective is that there is no "community" of people caring for each other, there is only the market and the economy. Devil take the hindmost.

Too Little Time
01-16-2016, 04:21 PM
One thing I've learned about the US and capitalist perspective is that there is no "community" of people caring for each other, there is only the market and the economy. Devil take the hindmost.

I think that is the closest anyone has come to agreeing with me on health care. Of course the correct element to bold was There are people who think that taking $88 billion in heath care away from the poor and making them pay premiums, deductibles, and co-pays is wrong.



Yes, I left out the word "wrong" in that sentence in my post.

Peerie Maa
01-16-2016, 04:25 PM
Perhaps the internet does not understand how Scotland works.

That is the way we finance our schools here. And the schools are free. So the question is not really dumb. (you pay a tax not a premium.)
Is that so?

Private schools
Educational standards, learning methods and prices
There are numerous private fee-paying schools in the US, serving a multitude of educational needs and educating around 10 per cent of children, a total of almost 5 million students in elementary schools and 1.2 million in secondary schools. Private schools include single-sex schools, schools sponsored by religious groups, schools for students with learning or physical disabilities, and schools for gifted children.






I personally think food and shelter is more important than health care. I don't understand your objection to free food and shelter. Perhaps you see yourself profiting from your healthcare system but not profiting from a similar system for food or shelter..


Really dumb. Are you competent to choose what treatment you need when you get sick? Are you equally incompetent at choosing what to eat and cooking it?
Stupid argument.

Norman Bernstein
01-16-2016, 04:26 PM
You seem to be unable to read. The average is not the minimum.

I wasn't talking to you.

Peerie Maa
01-16-2016, 04:29 PM
Devil take the hindmost.


I think that is the closest anyone has come to agreeing with me on health care.

Do you want to think about that some more?

PeterSibley
01-16-2016, 04:39 PM
Do you want to think about that some more?

He was looking for approval and misunderstood but I would have thought "devil take the hindmost'' would have been a clue.

Chris249
01-16-2016, 06:44 PM
Do individuals get a card for free food and shelter? And I don't mean a limited amount of food stamps or access to a food kitchen. Nor do I mean temporary shelter in large rooms shared with many others. I mean does the country provide all the food a typical person would eat? Does the country provide the typical shelter - a house, in whatever location desired to all? Why not socialize both food and shelter to the same extent?


Do individuals in the USA get a card for free police, defence and public roads?

If you get some services from the government without such a card then why not give some other services without a card?

By the way, as others have said we can budget pretty well for our food and rent; we are unlikely to suddenly need to eat $45,000 worth of food that we had no reason to know we would need.

johnw
01-16-2016, 07:36 PM
Darwin always wins.

Read it and weep.


http://info.worldbank.org/etools/docs/library/139494/S&P_AgingSocietiesSovereignRatings.pdf



http://s9.postimg.org/3oxofn58f/image.jpg (http://postimg.org/image/kpgkobi9n/full/)
sube fotos (http://postimage.org/index.php?lang=spanish)

According to your chart, the U.S. is in much worse shape than the U.K., which has socialized medicine. Was that your point?

George Jung
01-16-2016, 08:05 PM
Pretty smart-arsed respond, TLT; must've nicked a nerve, eh?

I wish you were correct - that you could get a knee replaced 'for as little' as $20,000. I sincerely doubt it - and in fact, I think even Norman's numbers are optimistic. Our 'system' is broken, and in need of a re-do.

PeterSibley
01-16-2016, 08:11 PM
According to your chart, the U.S. is in much worse shape than the U.K., which has socialized medicine. Was that your point?

I guess it must have been, he posted the chart.

isla
01-16-2016, 08:18 PM
That is the way we finance our schools here. And the schools are free. So the question is not really dumb. (you pay a tax not a premium.)



Yes it's a tax called National Insurance, ergo a premium for all intents and purposes. And FREE at point of need simply means you don't have to write a cheque every time you get treatment, because your National Insurance contributions have it covered. It's not rocket surgery.

PeterSibley
01-16-2016, 08:28 PM
Something else Australia has, a government run drug buying scheme called the Pharmaceutical Benefits Scheme PBS , where by the government lists certain drugs and then negotiates with the supplier on a price, a 25 million strong buying group has some power. Drugs on the scheme are substantially subsidised to the consumer and the initial buying price is far lower too. Other drugs are of course available but only at US prices.

''The cost of a medication is negotiated between the government, through the Department of Health, and the supplier of the drug. The agreed price becomes the basis of the dispensed price of the medication which is negotiated between the government and the Pharmacy Guild of Australia under the current Community Pharmacy Agreement. The dispensed price includes the wholesaler's markup, pharmacist's markup, and a dispensing fee. Pharmacies purchase PBS-listed drugs from the wholesaler or supplier, and claim the difference between the dispensed price and the patient co-payment contribution from Medicare Australia.''
https://en.wikipedia.org/wiki/Pharmaceutical_Benefits_Scheme

Norman Bernstein
01-16-2016, 09:22 PM
Pretty smart-arsed respond, TLT; must've nicked a nerve, eh?

I wish you were correct - that you could get a knee replaced 'for as little' as $20,000. I sincerely doubt it - and in fact, I think even Norman's numbers are optimistic. Our 'system' is broken, and in need of a re-do.

George, you'd have to imagine someone with a blown knee, dialing up hospitals and doctors all around the country to find the cheapest knee replacement, regardless of surgeon skill level.

I don't know about anyone else, but if I needed orthopedic surgery, I'd be looking for the best doctor, not the cheapest price. When I tore my ACL in 2008, I was recommended to an orthopedic group practice not far away from me. One of the partner surgeons, who does all the knees (the partners specialize) seemed very young, so the most important question I asked was, 'how many of these have you done?'. He answered that he had done 50-60 of them.... which seemed more than sufficient to me. Had he answered 'I've only done 3 of them', I might have looked for a different surgeon.

As it turned out, the surgery was successful, the postoperative physical therapy was challenging, but today, my knee is completely normal.

PeterSibley
01-16-2016, 09:42 PM
I'd imagine you are slightly better off than many of your fellow citizens Norman, quite a few people are forced to shop by price and hope that all will be well. I'd also rather a lot can't find $20 K let alone 50.

Norman Bernstein
01-16-2016, 10:06 PM
I'd imagine you are slightly better off than many of your fellow citizens Norman, quite a few people are forced to shop by price and hope that all will be well. I'd also rather a lot can't find $20 K let alone 50.

Your last line is the point I'm trying to make. A very large percentage of Americans simply don't have $20K lying around, even if they could find a hospital and doctor willing to accept that much. Sadly, a bad knee is not an emergent condition, so you can't jut wander into an emergency room, knowing that you can't be refused treatment, and let the taxpayers pick up the tab....

....instead, you're condemned to simply live with the pain and debilitation.... and it's truly awful. My closest friend, someone I've known since I was 7, has a bum hip and is desperately in need of a hip replacement.The pain he suffers daily, as he hobbles slowly with a cane, is a terribly sad thing to see.... but he can get the operation, because he is insured. The poor schnook who is not insured simply has to live with the pain and disability.... here in America, the richest country on the planet.

Is that something we think is perfectly reasonable and normal, in our society? That people who don't happen to have the $20K or whatever the price is, should be living in constant, awful pain?

PeterSibley
01-16-2016, 10:16 PM
Your last line is the point I'm trying to make. A very large percentage of Americans simply don't have $20K lying around, even if they could find a hospital and doctor willing to accept that much. Sadly, a bad knee is not an emergent condition, so you can't jut wander into an emergency room, knowing that you can't be refused treatment, and let the taxpayers pick up the tab....

....instead, you're condemned to simply live with the pain and debilitation.... and it's truly awful. My closest friend, someone I've known since I was 7, has a bum hip and is desperately in need of a hip replacement.The pain he suffers daily, as he hobbles slowly with a cane, is a terribly sad thing to see.... but he can get the operation, because he is insured. The poor schnook who is not insured simply has to live with the pain and disability.... here in America, the richest country on the planet.

Is that something we think is perfectly reasonable and normal, in our society? That people who don't happen to have the $20K or whatever the price is, should be living in constant, awful pain?


Apparently the answer to that is YES.

Norman Bernstein
01-16-2016, 10:30 PM
Apparently the answer to that is YES.

Well, that's the answer, in the United States... not so, in more enlightened countries.

PeterSibley
01-16-2016, 10:35 PM
Referring back to my reply earlier to Mr Time, some of us live in communities or societies in which to care for each other is seen as a mark of civilisation. There are those however who see the world through the Thatcherite lens of "there is no such thing as society, just a collection of competing individuals". I rather pity them..... and their victims.

Peerie Maa
01-17-2016, 06:57 AM
Referring back to my reply earlier to Mr Time, some of us live in communities or societies in which to care for each other is seen as a mark of civilisation. There are those however who see the world through the Thatcherite lens of "there is no such thing as society, just a collection of competing individuals". I rather pity them..... and their victims.

The fact that Maggie was so far up Ronny's bum that you could only see her heels when she said that is telling.

Too Little Time
01-17-2016, 12:26 PM
By the way, as others have said we can budget pretty well for our food and rent; we are unlikely to suddenly need to eat $45,000 worth of food that we had no reason to know we would need.

That was my point. Because you can pay for your food and rent, you see no need to provide food and rent for the poor. Certainly not at the level of food and rent you consume.

I think you are saying that no one can plan for unexpected medical expenses. Certainly the poor cannot. The middle class had the option to. The rich can. That pretty much matches the ability to plan for food and shelter costs.

Peerie Maa
01-17-2016, 12:37 PM
I think you are saying that no one can plan for unexpected medical expenses. Certainly the poor cannot. The middle class had the option to. The rich can. That pretty much matches the ability to plan for food and shelter costs.


By the way, as others have said we can budget pretty well for our food and rent; we are unlikely to suddenly need to eat $45,000 worth of food that we had no reason to know we would need.So a months food costs you $45,000 TlT? Really?

George Jung
01-17-2016, 12:37 PM
It's not a matter of enlightenment; it's as simple as the 1% has all the power*, has an incredibly good 'gig' going, and isn't about to give it up willingly. These for the most part aren't kinder/gentler folk, watching out for their fellow man.


* or does to this point. The average smo doesn't think he/she has any power, and 'refuses' to vote, to do anything legislatively that might balance the tables. We're seeing more on this topic of late - maybe we're heading towards an awakening?

George Jung
01-17-2016, 12:39 PM
Something else Australia has, a government run drug buying scheme called the Pharmaceutical Benefits Scheme PBS , where by the government lists certain drugs and then negotiates with the supplier on a price, a 25 million strong buying group has some power. Drugs on the scheme are substantially subsidised to the consumer and the initial buying price is far lower too. Other drugs are of course available but only at US prices.

''The cost of a medication is negotiated between the government, through the Department of Health, and the supplier of the drug. The agreed price becomes the basis of the dispensed price of the medication which is negotiated between the government and the Pharmacy Guild of Australia under the current Community Pharmacy Agreement. The dispensed price includes the wholesaler's markup, pharmacist's markup, and a dispensing fee. Pharmacies purchase PBS-listed drugs from the wholesaler or supplier, and claim the difference between the dispensed price and the patient co-payment contribution from Medicare Australia.''
https://en.wikipedia.org/wiki/Pharmaceutical_Benefits_Scheme

Prohibited here, by law, for govt. covered patients. GWB had that 'gem' in the legislation creating medicare part D. Nice bone for his friends, eh?

Too Little Time
01-17-2016, 12:40 PM
I wish you were correct - that you could get a knee replaced 'for as little' as $20,000. I sincerely doubt it

The difference in our positions is that I looked for information and reported it. You like others simply made a self serving statement. It is not that hard to remove your doubt by doing the search I suggested and looking at a couple tables in the Blue Cross Blue Shield study.


But the cost of a knee replacement was only used to show how much medical cost assistance was offered to those in need compared to the amount of food aid that was offered to those in need.

George Jung
01-17-2016, 12:43 PM
Maybe you're unaware I do this for a living, TLT. Total cost for a knee (surgery, orthotic, post op care, hosp charges) is going to be way north of $20,000. You're wrong on this. Get over it.

Too Little Time
01-17-2016, 12:51 PM
So a month's food costs you $45,000 TlT? Really?
That seems to be a number Chris249 chose to use. I could get by nicely on $300/month for myself. Some of the poor don't have that much.

That is the difference between the rich and the poor. The rich write down five and six figure numbers and claim distress. The poor write down 2 and 3 figure numbers.

Too Little Time
01-17-2016, 12:59 PM
Maybe you're unaware I do this for a living, TLT. Total cost for a knee (surgery, orthotic, post op care, hosp charges) is going to be way north of $20,000. You're wrong on this. Get over it.
Again you make a self serving statement rather than providing facts.

This report analyzed three years of independent Blue Cross and Blue Shield (BCBS) companies’ claims data for typical knee and hip replacement surgeries to further assess cost variations across the U.S. According to the report findings, some hospitals across the U.S. charge tens of thousands of dollars more than others for the same medical procedures, even within the same metropolitan market. The report, which examines these procedures in 64 markets across the country, found that their cost can vary by as much as 313 percent, depending on where the surgeries are performed.

Peerie Maa
01-17-2016, 01:01 PM
That seems to be a number Chris249 chose to use. I could get by nicely on $300/month for myself. Some of the poor don't have that much.

That is the difference between the rich and the poor. The rich write down five and six figure numbers and claim distress. The poor write down 2 and 3 figure numbers.

Yep, you're dumb.

George Jung
01-17-2016, 01:03 PM
Yep, you're dumb.


Nailed it.

I'm outta this one; decided to go talk to the door (it's a better conversation, and factual)

TomF
01-17-2016, 01:11 PM
Here in New Brunswick, the typical knee replacement prosthesis alone costs on average $9,300. To come to a full cost of the operation, you'd need to follow the value chain straight from the initial decision of the GP to refer the patient to a specialist, the diagnostic imaging, pre-op processes, the cost of the prosthesis + the operating room team + the facility overhead + any inpatient rehab + rehab after the operation. Factor in the costs of expected complications within the full population receiving knee replacements, and pro-rate those costs across all replacements.

The price is significantly higher than $20k even for an inexpensive operation, when all elements of the value chain are included. It will also vary by the location where the operation is performed - reflecting differences in the operating costs of the facility, the particular equipment used in that location, the volumes that location normally handles (costs reduce with high volume, but one must offset for regional accessibility factors) And that's before we talk about differential costs for choosing this physician over that in a system like America's where they will be paid quite different rates. Or diverging from the least-cost prosthesis option based on the patient's actual condition and (in many cases) the physician's preferences.

You forget, TLT, I do that end of the thing for a living.

Norman Bernstein
01-17-2016, 01:25 PM
Seeing as how there are millions of Americans who couldn't afford even $20K, the real tragedy is that many of them will simply have to suffer. A knee or hip replacement is elective surgery, which means that those without insurance or the money to pay for the operation will suffer horrible constant pain, a severe disability in walking (if hey can walk at all), and, in many cases, loss of employment (unless they happen to be in sedentary jobs, and even then, the pain doesn't go away).

Not even the ACA provides a solution for this problem. Patients probably can't even get the surgery and therapy, and then suffer the consequences of debt or bankruptcy, since surgeons and hospitals ordinarily won't schedule surgery for an elective procedure, unless the payment source is confirmed.

This is an example of where the ONLY known solution is universal single payer.

Of course, I'd love to have a chat with some conservative who has severe hip degeneration, and no assets to pay for the surgery, to see what he thinks of the health care system in the US.

Too Little Time
01-17-2016, 02:08 PM
You forget, TLT, I do that end of the thing for a living.
You are the second person to make that claim. Again someone - you this time, makes a self serving claim. It is not that hard to verify my comments.

I thought Blue Cross Blue Shield made their living that way. Perhaps you have heard of them.

TomF
01-17-2016, 02:23 PM
A colleague manages New Brunswick's contracts with Blue Cross, as it happens. We work with them for some aspects of delivery of drug programs here, as well as some other things. They are uniformly good at what they do, in my experience, but like all who do studies ... their methodology is very careful to specify the boundaries of the "value chain" in question.

I have not looked in any depth at the study you referenced. I did, on the other hand, recently see a presentation made by the managers of hip and knee replacement programs in New Brunswick, and presently am accountable for quarterly reporting on how New Brunswick is performing on some specific measures for those procedures. The number I cited a few posts ago came from that presentation, which went up to the Minister, and the Premier.

Part of my work with the managers of those joint replacement programs has been to develop project charters to clarify and improve those value chains, which in our case include independently operating general practitioners and specialists, Regional Health Authorities, those Authorities' own medical advisory groups, through to the way operating theaters are run in each facility offering the procedure. In the near future, I'll likely be facilitating process improvement projects addressing various parts of the value chain, looking to remove waste and variation and to develop more streamlined, effective, and meaningful management metrics for each step.

So yeah, I know something of what I am talking about. It's not a "self-serving claim," it's part of my day job. Will likely become a larger part of my day job within a couple of months too, once the data for the projects is assembled. I apologize if my professional life interferes with your preferred narrative.

t.

Peerie Maa
01-17-2016, 02:28 PM
Tom, I get the impression that TlT would sit down to a meal of steak and then tell the chef that he had cooked lamb.

Too Little Time
01-17-2016, 03:08 PM
I have not looked in any depth at the study you referenced. I did, on the other hand, recently see a presentation made by the managers of hip and knee replacement programs in New Brunswick, and presently am accountable for quarterly reporting on how New Brunswick is performing on some specific measures for those procedures. The number I cited a few posts ago came from that presentation, which went up to the Minister, and the Premier.


I did a search of "cost of knee replacement in canada." 2015 costs range from $14-20K CAD. I think $20K CAD is about $14K USD. These are averages not minimums.

From a Windsor, Ontario newspaper article on Canadian knee replacement surgery from 2014 (CAD):

It’s difficult to even estimate, but the Health Ministry pays the hospital $3,875 for the surgery, drugs and the artificial knee implant, plus $2,380 for a 3.5-day stay requiring food, nursing, housekeeping and other services. Then there’s the fees billed to OHIP by the orthopedic surgeon, the anesthetist and the radiologist who reads the X-rays, as well as follow-up home care and therapy care provided by the CCAC. The total cost to taxpayers is probably in the $10,000 range.

I even found a nice hospital in Hawaii that charges the uninsured $20-23K. List price is $33K.


But the price of knee surgery is not my point. My point is that ... everyone else seems to have missed it, you will not get it. You cannot even find internet data that supports my comments.

George Jung
01-17-2016, 03:16 PM
That's because YOU'RE WRONG!

TomF
01-17-2016, 03:22 PM
Interesting. As the quote says, "it is difficult to even estimate." The costs which the Windsor paper's article describes (under $4k for surgery, drugs, prosthesis) will not cover even the price of the prosthesis. This suggests to me either that the reporter got the information wrong, or that OHIP is underfunding the actual costs of the procedure. Or some combination of both. I expect, for instance, that they did not take into consideration the entire value chain - there's no mention of GP referrals, of diagnostic imaging or assessment, or pre-hab. While they mention the billings by the specialist physicians on the team and follow-up care, they have likely underestimated the number of contacts.

Let's pretend, however, that the payment to the hospital reported in the article is correct. The prosthesis costs borne by the hospital which I reported are also correct - I saw these numbers just 3 weeks ago; they were validated by the managers involved in cross-Canada contacts with their program-manager counterparts. If you think a little, this, you might agree, could be a factor in the length of wait-times for patients who'd like to actually have the procedure.

No facility which is under the gun to balance their budget will voluntarily take on elective procedures which are funded at a fraction of their actual cost. It suggests that there is a problem, but that you've not really understood what or where it is.

Chris249
01-17-2016, 04:24 PM
That was my point. Because you can pay for your food and rent, you see no need to provide food and rent for the poor. Certainly not at the level of food and rent you consume.

I think you are saying that no one can plan for unexpected medical expenses. Certainly the poor cannot. The middle class had the option to. The rich can. That pretty much matches the ability to plan for food and shelter costs.

I do actually see a need to provide shelter and food for the poor, which is why part of my taxes go towards doing that. The poor here are normally provided with perfectly reasonable houses.

Yes, I may have a better house and better food, but then again I could also choose to go to a "better" hospital. The thing is that a reasonable level of health care is seen as being the same as a reasonable level of policing, a reasonable level of national defence, a reasonable level of air traffic control, a reasonable level of restaurant health inspectors, etc. They are all things that it is better for us all, as a nation, to provide to our citizens.

Chris249
01-17-2016, 04:29 PM
That seems to be a number Chris249 chose to use. I could get by nicely on $300/month for myself. Some of the poor don't have that much.

That is the difference between the rich and the poor. The rich write down five and six figure numbers and claim distress. The poor write down 2 and 3 figure numbers.

Just to make it clear, I was not saying that you need $45k per month for food. However, one may suddenly require $45k per month for medical expenses.

Food and rent are comparatively stable expenses. Medical care is not, therefore your analogy between food/rent and medical expenses falls down.


As for your last line; that seems to be disparaging the rich as hypocrites, but I thought they were actually the model citizens, the winners in the dog-eat-dog world you seem to regard as the best way to live. Why praise a system but then disparage those who benefit from it the most?

Chris249
01-17-2016, 04:39 PM
How does it work, and are you happy with it?
We in the US hear nothing but horror stories about other nations healthcare plans. Can't ever see a doctor, month long waits, death panels etc.
So I'm asking. Say I live in your country and I've got a sinus infection and want to see the doc. How does it work, and what does it cost me?

Just to get back to the original question; I choose to go to a doctor who charges me about $40 over what he gets from the national healthcare cover. There are others who don't charge a "co payment" from the patient and just "bulk bill" the government. I then pay about $40 for antibiotics (if it's gone that far) and other medication.

If I wanted surgery, I'd go on the waiting list for a free op and pay for some incidental expenses like scans.

McMike
01-17-2016, 05:06 PM
I dislocated my knee for the first time when I was 25, 16 years ago. I was in the middle of nowhere and had to relocate myself. I spent the night in the woods in shock from the pain and hiked back a few miles to the car the next morning. I didn't have insurance so I let it heal by itself. I'd dislocated completely, once more, two years later, and this time I had insurance but it wasn't great. I never got surgery and now, that I've had insurance for three years , I'm afraid to get it fixed because they'll raise my rates. I currently pay $500/month for high deductible policy but at least it pays for my yearly. I have lived somewhere between pain and discomfort with my knee for 15 years because of our greedy healthcare system and for lack of a single payer national coverage.

How much do people in the countries with socialized medicine pay per month out of their taxes? Betcha, it's less than $500 per person and way more comprehensive.

P.I. Stazzer-Newt
01-17-2016, 05:10 PM
From five to fifteen percent.

Peerie Maa
01-17-2016, 05:22 PM
I paid just under 10% for both health and state pension. That was £287 ($409) per 4 weeks with no copays and heavily subsidised medication.

George Jung
01-17-2016, 05:57 PM
I dislocated my knee for the first time when I was 25, 16 years ago. I was in the middle of nowhere and had to relocate myself. I spent the night in the woods in shock from the pain and hiked back a few miles to the car the next morning. I didn't have insurance so I let it heal by itself. I'd dislocated completely, once more, two years later, and this time I had insurance but it wasn't great. I never got surgery and now, that I've had insurance for three years , I'm afraid to get it fixed because they'll raise my rates. I currently pay $500/month for high deductible policy but at least it pays for my yearly. I have lived somewhere between pain and discomfort with my knee for 15 years because of our greedy healthcare system and for lack of a single payer national coverage.

How much do people in the countries with socialized medicine pay per month out of their taxes? Betcha, it's less than $500 per person and way more comprehensive.


McMike.... with the ACA, they can't 'punish' you for pre-existing conditions, or for having surgery. If they can fix it (you've waited a long time.... that ship may have sailed) - get it done.

McMike
01-17-2016, 05:59 PM
I paid just under 10% for both health and state pension. That was £287 ($409) per 4 weeks with no copays and heavily subsidised medication.

If you're including state pension (Social Security here) I pay $300/month for that. For a total of $800/month. And I'm not guaranteed to get my state pension because we're busy paying for two wars and a financial collapse caused by rich hedge fund managers.

So here we are, the USA pays double than that of other real first world countries for way fewer services. I can't even fathom how stupid we are as a nation to have let this happen.

George Jung
01-17-2016, 06:02 PM
Self-loathing ain't gonna fix this, McMike. The real question should be (and where we focus our energy) - how to 'fix' this mess? Put a Republican in - not a chance in hell (sorry, Paul). Either Bernie or Hillary - we've got a shot. But even that will be up hill; lots of moneyed interests and bought up Congresscritters to overcome.

McMike
01-17-2016, 06:02 PM
McMike.... with the ACA, they can't 'punish' you for pre-existing conditions, or for having surgery. If they can fix it (you've waited a long time.... that ship may have sailed) - get it done.

They can't exclude me from being insured but I won't be able to afford the higher premiums. What's the difference?

Norman Bernstein
01-17-2016, 06:03 PM
I can't even fathom how stupid we are as a nation to have let this happen.

It's because of the people we elect, and the financial interests (i.e., big money) that control and constrain what we can do as a people to make a better America.

Get the money out of politics, and suddenly, the 'impossible' will become the 'practical'.

George Jung
01-17-2016, 06:05 PM
They can't exclude me from being insured but I won't be able to afford the higher premiums. What's the difference?


Having surgery/using your insurance should have no effect on your premiums. Is your insurance through work? I have to buy my own insurance - and there were no questions on health issues, meds etc. on the application.

Things are a bit different now.

McMike
01-17-2016, 06:15 PM
Self-loathing ain't gonna fix this, McMike. The real question should be (and where we focus our energy) - how to 'fix' this mess? Put a Republican in - not a chance in hell (sorry, Paul). Either Bernie or Hillary - we've got a shot. But even that will be up hill; lots of moneyed interests and bought up Congresscritters to overcome.

Agreed, but self-loathing may be all we have left to do. I've sincerely and with great guilt pondered this question personally on many occasions. I can't afford to take time off to protest or organize. I've written my reps on many occasions and get the same canned response. I've voted for the lesser of evils, I talk about the important issues to friends and co-workers to the point of being annoying. I will vote for Sanders in the primaries and if he loses, I'll vote for Clinton when the time comes.

I often think that those, like you, who work in the healthcare industry, needs to speak out, not that you haven't here. But I fear that many, unlike you, see too much profit from the status quo and forgo speaking the truth. I'm glad that you're speaking out and I frankly, have a huge amount of respect for you and people like you. I wish you were my Doc, the one I have only sees $$$$ when I walk through the door.

George Jung
01-17-2016, 06:18 PM
Again - your premiums shouldn't change after you have surgery. Get it checked out/fixed, if that's possible.

McMike
01-17-2016, 06:23 PM
Having surgery/using your insurance should have no effect on your premiums. Is your insurance through work? I have to buy my own insurance - and there were no questions on health issues, meds etc. on the application.

Things are a bit different now.

Yes, my insurance is through work and I had to list all pre-existing conditions when I applied for my insurance. Maybe my assumption is incorrect but I don't trust them because I have no way of validating the reasons why my health insurance policy gets more expensive every year regardless of the ACA and why my premium increase year to year is still way outta step with inflation. I honestly feel so helpless about it. I have all but resigned to the idea that when I get sick, now or in my old age, it will wipe me out financially and the rest of my life will simply be subsisting instead of enjoying all of my hard work. This is not the American Dream.

McMike
01-17-2016, 06:24 PM
Again - your premiums shouldn't change after you have surgery. Get it checked out/fixed, if that's possible.

Fair enough, you would know better than I, I'll talk to my doc at my next appointment.

George Jung
01-17-2016, 06:27 PM
Do that - and ask these same questions. As a patient - I've been told my rates (and they're high!) are based on my advanced age alone! I don't recall any questions on current medical problems - and again, as I understand it - they can't be 'held against you'. Being in a group - I'd expect those in your age bracket to be charged similar amounts.

McMike
01-17-2016, 06:27 PM
It's because of the people we elect, and the financial interests (i.e., big money) that control and constrain what we can do as a people to make a better America.

Get the money out of politics, and suddenly, the 'impossible' will become the 'practical'.

And you're voting for Clinton in the primaries? Forgive me, but I see a major conflict between who you support an what agenda you think should be implemented?

Peter Malcolm Jardine
01-17-2016, 06:50 PM
I don't deny that there are studies that draw that conclusion. But there are people who have examined the data in those studies and made other conclusions.

I tend to believe the other studies. I say that because so many people exhibit poor money management - credit card debt, college loan debt, lack of retirement savings, lack of emergency savings.

Commenting on the study you quoted. At that time family coverage for a high deductible health care insurance - $10K deductible with $20 million max benefit, cost under $12K/year. Easily manageable by a "solidly middle class" family. People choose to spend their money the way they want. They make poor decisions. And it easier to place blame on medical bills rather than poor money management decisions.


Wow, you think $1000 dollars a month for a healthcare premium is reasonable, with a $10,000 dollar deductible? Okay, you are not talking about the middle class in America.

McMike
01-17-2016, 06:51 PM
Do that - and ask these same questions. As a patient - I've been told my rates (and they're high!) are based on my advanced age alone! I don't recall any questions on current medical problems - and again, as I understand it - they can't be 'held against you'. Being in a group - I'd expect those in your age bracket to be charged similar amounts.

I will, and thanks for setting me straight Doc.

McMike
01-17-2016, 06:53 PM
Wow, you think $1000 dollars a month for a healthcare premium is reasonable, with a $10,000 dollar deductible? Okay, you are not talking about the middle class in America.

He needs to define what middle class is to him before you call him crazy but yeah, middle class in this country is a median household income of $50,000/ year if he didn't already know that.

Norman Bernstein
01-17-2016, 07:07 PM
And you're voting for Clinton in the primaries? Forgive me, but I see a major conflict between who you support an what agenda you think should be implemented?

I have exactly the SAME idealistic desires as Bernie Sanders... but fortunately, I also have an element of pragmatism. Frankly, I really don't care whether Hillary or Bernie are nominated... I only care that Trump or Cruz (or Rubio) NOT be elected.

If Hillary is elected, she won't fulfill every idealistic objective that Bernie Sanders is campaigning on... and she'll be more amenable to compromise in order to get SOMETHING done. If Bernie is elected, he'll fall far shorter than Obama has, in terms of getting his agenda implemented... the Presidency has a way of providing a President with a huge, heaping helping of humility, once they recognize that they are NOT dictators.

Why do I feel this way? Tell me about the LAST President who swept into office with high ideals, and managed to get the majority... or even a substantial portion... of his agenda accomplished.

Real life, in DC, doesn't work that way.

(And I haven't decided who to vote for, in the primaries, yet. I'll wait until the day before the primaries, see who leads the GOP, and then look at the match-up polls. Whichever one looks like a better shot at winning the whole megillah will get my vote).

McMike
01-17-2016, 07:09 PM
Norm, the ACA was a compromise, it wasn't good enough. The field has changed, the Republicians won't compromise, neither should we.

George Jung
01-17-2016, 07:13 PM
Reality intruding, unfortunately. ACA was a compromise? You better believe it - because the votes weren't there, for single payer. But make no mistake - it's 'the camels nose in the tent', and the Republicans know it. They also know there's growing support for it, and for.... Single Payer. You're looking for a home run; you can keep swinging for the fence - and striking out. A better tact - bunts and base hits.

AFA 'what can the next President do'? It all depends on us - who we send to Congress. And that's state by state.

Norman Bernstein
01-17-2016, 07:15 PM
Norm, the ACA was a compromise, it wasn't good enough.

I agree. It WASN'T enough. It WAS, however, what was possible. As they say, 'politics is the art of the possible.'


The field has changed, the Republicians won't compromise, neither should we.

THAT is precisely the attitude of people like RonW.

Government IS compromise.... because without compromise, it becomes nothing but a power grab. The only way to be completely uncompromising is to control ALL of government... a political dictatorship. Is that REALLY what you want?

Presidents may campaign by appealing to their base... but once they get into office, they are honor-bound and obligated to represent ALL interests. I don't want a left wing political dictator, any more than I want a right wing one... I want EVERYONE's interests to be represented, and the best way for that to happen is negotiation and compromise.

Tell me... if, by chance, Bernie Sanders gets elected... but, as we know will happen, the house will remain in strong Republican control, and the senate will not have Democratic control... do you REALLY expect that Sanders' policy objectives are going to be some sort of fait accompli? Or will he face the same damn problems that Obama has faced, and in order to get ANYTHING done, he won't have to compromise?

Norman Bernstein
01-17-2016, 07:16 PM
George said it eloquently:


You're looking for a home run; you can keep swinging for the fence - and striking out. A better tact - bunts and base hits.

RonW
01-17-2016, 07:16 PM
Reality intruding, unfortunately. ACA was a compromise? You better believe it - because the votes weren't there, for single payer. But make no mistake - it's 'the camels nose in the tent', and the Republicans know it. They also know there's growing support for it, and for.... Single Payer. You're looking for a home run; you can keep swinging for the fence - and striking out. A better tact - bunts and base hits.

AFA 'what can the next President do'? It all depends on us - who we send to Congress. And that's state by state.

Votes wasn't there....who are you kidding or are you just that poorly informed....

Yes the votes was there for single payer, the ACA was passed 100% on democrat votes, in the house and the senate.....

Norman Bernstein
01-17-2016, 07:18 PM
Yes the votes was there for single payer, the ACA was passed 100% on democrat votes, in the house and the senate.....

...and you actually think that 100% of Democratic senators would have passed single-payer... and pissed off big pharma and the insurance companies who feed their campaigns? You have a VERY simplistic view of what government is.

McMike
01-17-2016, 07:19 PM
I agree. It WASN'T enough. It WAS, however, what was possible. As they say, 'politics is the art of the possible.'



THAT is precisely the attitude of people like RonW.

Government IS compromise.... because without compromise, it becomes nothing but a power grab. The only way to be completely uncompromising is to control ALL of government... a political dictatorship. Is that REALLY what you want?

Presidents may campaign by appealing to their base... but once they get into office, they are honor-bound and obligated to represent ALL interests. I don't want a left wing political dictator, any more than I want a right wing one... I want EVERYONE's interests to be represented, and the best way for that to happen is negotiation and compromise.

Tell me... if, by chance, Bernie Sanders gets elected... but, as we know will happen, the house will remain in strong Republican control, and the senate will not have Democratic control... do you REALLY expect that Sanders' policy objectives are going to be some sort of fait accompli? Or will he face the same damn problems that Obama has faced, and in order to get ANYTHING done, he won't have to compromise?

I expect Sanders to do one thing that Obama didn't do nearly enough; make a sh17 load of noise, call them out on their hipocracy, their lies. Do battle! Yeah, in the end, won't have gotten any more done than Clinton, but at least he'll have tried to awaken the people.

George Jung
01-17-2016, 07:20 PM
That really hurts - being called 'ill-informed' by RW! Arrrgh!

Just kidding - yes, one of us is ill-informed. 'tis not I.

'The votes' were there - after Single Payer was taken off the table. Try again, Old son.

RonW
01-17-2016, 07:27 PM
...and you actually think that 100% of Democratic senators would have passed single-payer... and pissed off big pharma and the insurance companies who feed their campaigns? You have a VERY simplistic view of what government is.

Well how interesting, it would seem that you are admitting to the fact that the democrats conspired with big pharma for profits instead of looking out for the their constituents.

Norman Bernstein
01-17-2016, 07:29 PM
I expect Sanders to do one thing that Obama didn't do nearly enough; make a sh17 load of noise, call them out on their hipocracy, their lies. Do battle! Yeah, in the end, won't have gotten any more done than Clinton, but at least he'll have tried to awaken the people.

McMike, you describe a perfectly normal impulse... it's what WE do here, in the bilge....

...but is it productive for a President to indulge in what might 'feel good', but accomplishes nothing, and may even make it far harder to get anything done?

They say that congress is far more 'collegial' than what gets represented in the media, and I believe it. Senators and congressmen may despise the politics of their brothers on the other side of the aisle, but the smarter ones know that they NEED that collegiality to be able to play ball and actually DO things. Sanders himself may be far more collegial than the way he represents himself on the campaign trail... but then again, you'd have to acknowledge that his policy agenda is designed to win an election....

...and has NOTHING to do with what he can accomplish, if he's elected.

Like I've said a million times before, people are destined to ALWAYS be disappointed in their heroes, AFTER the election.

Norman Bernstein
01-17-2016, 07:29 PM
Well how interesting, it would seem that you are admitting to the fact that the democrats conspired with big pharma for profits instead of looking out for the their constituents.

Some indeed did.... and ALL of the Republicans certainly did.

RonW
01-17-2016, 07:35 PM
Some indeed did.... and ALL of the Republicans certainly did.

The dems voted yea, the repubs voted nay, now which ones betrayed the people and conspired with this evil big pharma ?

George Jung
01-17-2016, 07:39 PM
All of the Republicans, and some of the Democrats.

You paying attention?

McMike
01-17-2016, 07:39 PM
McMike, you describe a perfectly normal impulse... it's what WE do here, in the bilge....

...but is it productive for a President to indulge in what might 'feel good', but accomplishes nothing, and may even make it far harder to get anything done?

They say that congress is far more 'collegial' than what gets represented in the media, and I believe it. Senators and congressmen may despise the politics of their brothers on the other side of the aisle, but the smarter ones know that they NEED that collegiality to be able to play ball and actually DO things. Sanders himself may be far more collegial than the way he represents himself on the campaign trail... but then again, you'd have to acknowledge that his policy agenda is designed to win an election....

...and has NOTHING to do with what he can accomplish, if he's elected.

Like I've said a million times before, people are destined to ALWAYS be disappointed in their heroes, AFTER the election.

Condescending Norm and I'm trying really hard not to have a 'knee-jerk' reaction to you, you know, let my emotions get the better of me. . .

George makes a point about the long game and small gains being better than none. Normally, I'd agree, in this case, I literally feel the clock ticking. I'm 41, it's not a question of if, but, of when I'll get sick. Hillary has all but explicitly said she'd not pursue single payer, Sanders has explicitly said he'd pursue it. It's one of the largest things holding the middle class by the neck. It needs to get done. In this political climate, the only hope we have is if the left keeps reminding people why they need it. Hillary is not going to do that, she's bought and paid for.

Question; has Clinton stated what will be her "bunt" to keep momentum towards single payer?

RonW
01-17-2016, 07:54 PM
All of the Republicans, and some of the Democrats.

You paying attention?

Did norm e-mail you that response ? Or did you just copy it from above ?

Norman Bernstein
01-17-2016, 08:11 PM
Condescending Norm and I'm trying really hard not to have a 'knee-jerk' reaction to you, you know, let my emotions get the better of me. . .

I have no clue as to why you feel I'm being 'condescending'... I'm simply expressing an opinion here.


George makes a point about the long game and small gains being better than none. Normally, I'd agree, in this case, I literally feel the clock ticking. I'm 41, it's not a question of if, but, of when I'll get sick. Hillary has all but explicitly said she'd not pursue single payer, Sanders has explicitly said he'd pursue it.

They can SAY whatever they want... what the voters need to decide is whether it's a reasonable goal that might actually be accomplished, or something which plays well in electioneering, but bears no relationship to reality. The issue here is whether you believe that Sanders has whatever 'magic sauce' is required to force a monumental change to US health care that BILLIONS of dollars are lined up against, compared to what might be a simple statement of honesty from Hillary Clinton, in acknowledging that the power and money opposed to single payer are probably insurmountable for the same result.

Does anyone believe, for example, that Donald Trump is going to build an impenetrable wall along the border with Mexico.. and get Mexico to pay for it?

Why would we dismiss that silly idea, yet hold on to the hope for something that is nearly the equivalent, in health care? Damn, we couldn't even get a 'public option' as part of the ACA... it demonstrates the FIERCE opposition to the idea. Those billions of dollars represent powerful vested interests, who are NOT going to give up.


It's one of the largest things holding the middle class by the neck. It needs to get done. In this political climate, the only hope we have is if the left keeps reminding people why they need it.

The country is more or less evenly split, between conservative and liberal adherents. Elections are won by just a few percent, and have been, for a long while. It's not hard to convince liberals of the need for single payer health care.... but it's impossible to convince conservatives, and BILLIONS of influence dollars are going to keep it that way. Maybe not forever... I'd like to think that eventually, the country will come around to the idea.... but pragmatism wins out of idealism, in the end.


Hillary is not going to do that, she's bought and paid for.

It is precisely THAT kind of stuff that really gets under my skin. Hillary and Bill have made millions in the past 16 years, and money can't possibly be the motivating factor. For ANY President, 'legacy' is the key motivation. If she WERE able to get single payer implemented, it would be the biggest legacy score of the century.... the motivation to accomplish that would be VASTLY more powerful than anything else.

You want to know what kind of legacy a President DOESN'T want? Failure. Bitter, highly contested, battle-scarred FAILURE.


Question; has Clinton stated what will be her "bunt" to keep momentum towards single payer?

Not as far as I can tell. I believe she's more concentrating on things which she MIGHT be able to achieve. I hate to be a downer, but few Presidents get to enjoy any sort of stellar 'legacy' as a result of their terms in office. More often, their legacy is clouded, and if they get remembered by posterity at all, it's for the incremental things they've done, not because they accomplished anything REALLY big.

Consider JFK, the President with the strongest legacy in the last 70 years. What did he do? He had one huge failure: the Bay of Pigs. He had one 'success', the Cuban Missle Crisis, but even THAT falls apart under close examination, because HIS compromise was to remove missles from Turkey, in order to get the Russians to turn around. In practical terms, it wasn't much of a legacy....

...aside from thousands of public buildings bearing his name, that is.

McMike
01-17-2016, 08:47 PM
legacy....

Sure, legacy. You're so jaded that you believe it's all about legacy? Yeah, I can see that there is always that thing that drives people, "what will they say about me when I'm dead". Maybe you're right, it's all about a selfish pursuit of acknowledgement, validation. Sad thought, not sure which is sadder; the idea that you might be right or that you truly believe that legacy is their primary motivation. Funny, made a lot of judgement calls in my life, done right for the greater good at great expense to myself, not once did I think, "their gonna love this at my funeral". Guess I'm made of different stuff.

Keith Wilson
01-17-2016, 09:15 PM
Consider JFK . . . Johnson accomplished far more than JFK, with Vietnam being his one huge screwup.

Norman Bernstein
01-17-2016, 09:39 PM
Sure, legacy. You're so jaded that you believe it's all about legacy?

Mike, I've been merely expressing my opinion here... but since you accused me of being 'condescending', what's that personal accusation of me being 'jaded' all about? I believe you are completely sincere in your beliefs. Please accord me the same respect.


Yeah, I can see that there is always that thing that drives people, "what will they say about me when I'm dead". Maybe you're right, it's all about a selfish pursuit of acknowledgement, validation. Sad thought, not sure which is sadder; the idea that you might be right or that you truly believe that legacy is their primary motivation.

Then what IS the motivation? It surely cannot be money... the Clintons are rolling in the stuff, and could make far more, without the Presidency.


Funny, made a lot of judgement calls in my life, done right for the greater good at great expense to myself, not once did I think, "their gonna love this at my funeral". Guess I'm made of different stuff.

With all due respect, you're not a politician, and you're not going through the extraordinarily difficult task of running for President. Most of us have very busy lives, but the physical toll of running for President must be truly exhausting... I can see the prestige, the sense of accomplishment, as being motivating factors. I can see the desire to do some good as a motivating factor. And I can see legacy as being a motivating factor.... but I don't see money, in this particular case, as being the factor. Is Bernie Sanders running for the sake of money?

McMike
01-17-2016, 09:57 PM
Mike, I've been merely expressing my opinion here... but since you accused me of being 'condescending', what's that personal accusation of me being 'jaded' all about? I believe you are completely sincere in your beliefs. Please accord me the same respect.



Then what IS the motivation? It surely cannot be money... the Clintons are rolling in the stuff, and could make far more, without the Presidency.



With all due respect, you're not a politician, and you're not going through the extraordinarily difficult task of running for President. Most of us have very busy lives, but the physical toll of running for President must be truly exhausting... I can see the prestige, the sense of accomplishment, as being motivating factors. I can see the desire to do some good as a motivating factor. And I can see legacy as being a motivating factor.... but I don't see money, in this particular case, as being the factor. Is Bernie Sanders running for the sake of money?

Being jaded is not necessarily a negative thing, in the sense that it's a normal human reaction to constant stimulus, we become desensitized . . . I meant, in this case, that you were possibly so worn out by selfish acts within our government that you couldn't imagine someone being, at least in part, selfless.

If Clinton isn't in it for the money, I have a hard time imagining Her motivations based on her actions. YMMV.

I could be wrong but, no, I can't imagine Sanders is doing it for the money, his actions show a particular altruism. While you may consider it a flaw, I don't.

Norman Bernstein
01-17-2016, 10:04 PM
If Clinton isn't in it for the money, I have a hard time imagining Her motivations based on her actions. YMMV.

Yet, you accused her of 'being bought and sold'.


I could be wrong but, no, I can't imagine Sanders is doing it for the money, his actions show a particular altruism. While you may consider it a flaw, I don't.

I certainly DON'T consider it a flaw.

However, being altruistic is not a formula for success. Loads of people with the best intentions have failed.

Durnik
01-17-2016, 10:11 PM
...

AFA 'what can the next President do'? It all depends on us - who we send to Congress. And that's state by state.

^This. Here's (https://ballotpedia.org/United_States_Congress_elections,_2016) what's coming up - and some commentary.


A total of 469 seats in the U.S. Congress (https://ballotpedia.org/U.S._Congress) (34 Senate (https://ballotpedia.org/United_States_Senate) seats and all 435 House (https://ballotpedia.org/United_States_House_of_Representatives) seats) are up for election on November 8, 2016.[1] (https://ballotpedia.org/United_States_Congress_elections,_2016#cite_note-1) The big story of the 2016 congressional election cycle is whether or not the Democratic Party (https://ballotpedia.org/Democratic_Party) will be able to regain control of the Senate (https://ballotpedia.org/United_States_Senate_elections,_2016). In order to take the chamber back, Democrats will need to gain five seats in 2016, a difficult but not impossible task. The majority of vulnerable seats are held by Republican incumbents, many of whom are freshmen who were swept into office in the Republican wave of 2010. Additionally, Democrats only have 10 seats to defend in 2016, while 24 Republican incumbents are up for re-election.[2] (https://ballotpedia.org/United_States_Congress_elections,_2016#cite_note-2)
There is significantly less at stake in the U.S. House (https://ballotpedia.org/United_States_House_of_Representatives_elections,_ 2016) in 2016, as control of the chamber is very unlikely to be in question. In order to flip the chamber, the Democratic Party would need to pick up 30 seats, a nearly impossible task. While it would be very difficult for the Democratic Party to gain control of the chamber in this election cycle, Democrats can still hope to reduce the majority that the Republican Party (https://ballotpedia.org/Republican_Party) holds. Republicans currently hold their largest majority in the U.S. House since 1928.[3] (https://ballotpedia.org/United_States_Congress_elections,_2016#cite_note-division-3)



So yes, we need to do more than just elect a President - we need to shift Congress, & the best way to do that is mobilize a huge contingent of liberal voters - and that might just best be done by giving them a liberal Presidential Candidate to rally behind.

http://cdn.shopify.com/s/files/1/0904/4966/products/BERNIE2016_FullShirt_White_large.png

Wait, Wait! I mean -

https://s-media-cache-ak0.pinimg.com/736x/84/f0/03/84f003e4339d43a75f7566fb5aaca72a.jpg

Meanwhile,

http://40.media.tumblr.com/dc6dc10293993f0efb860f1c12390ae2/tumblr_nrgn2eoEAd1qdny86o1_500.jpg

One has history we can count on - the other is hard to tie down. Who are ya gonna trust?

ETA: I _want_ one of those t-shirts! ;-)

enjoy
bobby