Steve
Mostly Harmless
Health care in the US is very bad by any independent standard. We spend more for less than anyone else in the world. Our emergency care is top notch, though. If I'm going to get hit by a car, there's no place I'd rather be.
Canada? What the heck do they know?
- Thread starter Bob Hubbard
- Start date
Empty Hands
Senior Master
Don't count on it. Most health insurance companies have entire departments devoted to finding reasons to deny claims. They pay performance bonuses based on number of claims refused. The sicker you are, the more you cost, the greater incentive to find a reason to deny your claim.
God help you if you have a "pre-existing condition", the illness or it's treatment falls outside the scope of the coverage (particularly with "experimental" treatments), or you go over your limits. One policy I had had a $500,000 lifetime limit. You could go through that in a few months with something like cancer.
Health insurance may have problems in the USA. But I believe the quality of health care in the USA is very high. When I've had to work outside the US in the past, I've always purchased repatriation insurance. Whether I get hit by a bus or fall ill from some inner daemon while outside the USA, I want a quick ride home on a fast jet to see US doctors. But to each, his own.
Nomad
Master Black Belt
As a transplanted Canadian who's been living in California for 8 years, and whose father was both a physician in Canada and the US (for a short time) and also worked for OHIP (Ontario Health Insurance Plan) for many years, I think I have a reasonable perspective on health care in both countries.
On Health Care... both the US and Canada have something to learn from each other, and neither are ideal.
Canada has universal health care which comes out of the tax base. The provincial and federal governments have agencies that set fees for physicians on a yearly basis and act to police doctors who try to cheat the system. This keeps overall costs comparatively low. The downside to this is that many years of cuts or spending holds in budgets mean that some areas are chronically underserviced, and that people can end up waiting a long time for treatment, especially if they require expensive diagnostics (eg. MRI) or surgeries. Many people have died from treatable conditions while on these type of waiting lists.
In the US, treatment tends to be quicker for those with good insurance. The cost of health care services and insurance are MUCH MUCH higher than in Canada, to the point where a large number of people have no health care insurance whatsoever, and even those in good professions often have difficulty if they are temporarily out of work meeting these basic costs.
The answer for both countries would be to have a multi-tier system, where universal health care does exist so that people with medical need are not turned away because of an inability to pay, but which can be upgraded with additional spending (on the part of the individual or employers as a perk) to a faster/better care standard. In the US, costs per capita should decrease substantially, while in Canada, those with means would have an option to go beyond the minimum, which would then help support new equipment and expanded service costs for hospitals and medical groups.
Unfortunately, both countries think they have it "right", and changes to one are seen as a bow to socialism, while changes to the other are seen as catering to the privileged while letting the poor(er) languish. There is great resistance to changes of this type on both sides of the border.
On Health Care... both the US and Canada have something to learn from each other, and neither are ideal.
Canada has universal health care which comes out of the tax base. The provincial and federal governments have agencies that set fees for physicians on a yearly basis and act to police doctors who try to cheat the system. This keeps overall costs comparatively low. The downside to this is that many years of cuts or spending holds in budgets mean that some areas are chronically underserviced, and that people can end up waiting a long time for treatment, especially if they require expensive diagnostics (eg. MRI) or surgeries. Many people have died from treatable conditions while on these type of waiting lists.
In the US, treatment tends to be quicker for those with good insurance. The cost of health care services and insurance are MUCH MUCH higher than in Canada, to the point where a large number of people have no health care insurance whatsoever, and even those in good professions often have difficulty if they are temporarily out of work meeting these basic costs.
The answer for both countries would be to have a multi-tier system, where universal health care does exist so that people with medical need are not turned away because of an inability to pay, but which can be upgraded with additional spending (on the part of the individual or employers as a perk) to a faster/better care standard. In the US, costs per capita should decrease substantially, while in Canada, those with means would have an option to go beyond the minimum, which would then help support new equipment and expanded service costs for hospitals and medical groups.
Unfortunately, both countries think they have it "right", and changes to one are seen as a bow to socialism, while changes to the other are seen as catering to the privileged while letting the poor(er) languish. There is great resistance to changes of this type on both sides of the border.
Gordon Nore
Senior Master
It's certainly how I feel, but I think Canadians are becoming more individualistic. I only know about the prairies and the outports because my parents told me about them -- I grew up in a big-city highrise with cable. A lot of Canadians who perceive the US model to be preferable have spent their lives with Provincially-issued health card in their wallets, and thus have never seen a doctor's bill.
If I went to hospital tomorrow for surgery, I wouldn't necessarily see the bill. I would see a statement from my workplace-based private ensurer indicating what was paid out to put me in a semi-private room, etc, but I likely would not be shown what was paid through my provincial entitlement for the surgeon, the anaesthatist, etc.
A previous Provincial government de-listed a preponderance of eye care from OHIP. It remains a shock to my system to be handed a bill at the eye doctor's. I can certainly afford it, but it bothers me to think of people (adults in particular are impacted by this change) walking around with inadequate vision because they can't pay the eye doctor.
Similarly, when Tucker was very little we had to get his ears checked at Paducah Baptist Hospital during a visit to Kentucky. It was a slam dunk -- the doc found what we expected, an ear infection, and wrote a script. The staff were professional and kind. The hospital was gleaming. But there was this bill for $200 for five minutes of relatively uncomplicated care. We paid it and discovered that we had a lengthy wait ahead to bill our OHIP or my privated extended provider. So we left it that.
That same care could have been provided more cheaply and efficiently -- in Ontario or Kentucky -- by a registered nurse practitioner, just as easily as an ER doc, resident, or intern. A lot of non-urgent and wellness care is being provided by doctors ($$$) than necessary. I'm not implying that docs here or there are greedy, just that they're doing things they need to be doing.
Whether you live in Canada or the US, in the year 2011 the largest graduating class in history turns 65. Immigration patterns not withstanding, we face a largish population of old folks who need care. Obviously that will create a demand for emergency medicine, paramedics, and geriatriatrists. New models of care will have to be created, such as community health centres, which have been popping up all over my province. These provide a kind of one-stop-shopping -- medicine, therapeutic massage, chiropody, social work, etc.
Such models are vital in treating low-income and transient populations who may not have a 'family doctor' and who may be inclined to let small health problems become big ones and end up in ERs. It will be interesting to see down the road if it's profitable or worthwhile for the private sector to maintain its role in providing care to Americans.
Insurance, whether it comes from a private source or the gov't, is about how care is paid for. I think to the systems work, we need to look seriously at the kind of care that is being provided and how it is being provided.
Gordon Nore
Senior Master
Understood, and, sadly, accepted. The problem isn't totally our system in Canada IMO -- it's Canadians. I must confess that when my father took a fall years ago, and we had a wait for an MRI, I put him in the car, drove to Lockport, NY, and paid cash for it. Hairline fracture.
This is where I differed with Exile's analysis of our love for each other in Canada. In the last number of years, tax cutting has become the new religion. Old School Democratic Socialists like me are creaking dinosaurs:
- Mike Harris and Tories swept to power in Ontario in 1995 with the promise of unprecedented cuts, which crippled school boards and health care. We're still fixing the mess. Investment in infrastructure idled for years and has not picked up enough.
- His successor, Liberal Party Premier Dalton McGuinty, signed a zero-tax pledge with the Canadian taxpayers' rights group even though he was a slam dunk to win and despite the fact that he had not yet seen the books, which had been cooked by his predecessor.
- Premier Ralph Klein in Alberta was similarly famous for his bootstrapping. He tried to scrimp on health costs by de-certifying union hospital cleaners and kitchen staff making less than ten bucks an hour. Cheap and mean.
- Federal Liberals and Conservatives have been promising a line or reduction on taxes for years, whether or not it's feasible at the moment they promise it.
- You can't get elected mayor or dog catcher if you are honest with voters and say that everything is provided has to be paid for.
We can fix everything you've described if we (1) are prepared to pay for it, and/or (2) very carefully manage private ensurers. As I posted above, we need to substantially re-imagine delivery if we want to be the kind of people we like to tell the world we are.
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Gordon Nore
Senior Master
Bill, in fairness, I should qualify some of my earlier comments about the role of monarchy up here. Since I'm a natural born citizen, I haven't had to swear an oath to God and the Queen since Cub Scouts. However, new Canadians in Citizenship Court, do have to swear loyalty to the Queen. This issue (both God and the Queen) has come up before around the swearing in of police officers. I think they've been given the choice, but I can't, well, swear to it.
My wife had a co-worker, a nurse practitioner, from Dublin. I asked her once if she was still British Subject or had opted for Canadian Citizenship. She had wanted to become a Canadian but would not swear an oath to the Queen.
Since the repatriation of the (former) British North America Act to Canada in the eighties, and the subsequent Canadian Constitution and Charter of Rights and Freedoms, it makes more sense to me to swear allegiance to our governing principles than our governors. That's how it's done south of 40.
It's good thing I don't have to re-up my citizenship. I might have to cross my fingers behind my back.
Gordon Nore
Senior Master
I was commenting on the quality of medicine, not the availability of the care, nor its cost. I certainly could be wrong. I've never been treated in the US, so I should shut my mouth.
Ramirez
Black Belt
Universal health care is nice but I think it is pretty useless without pharmacare which I think the UK has.
As for the financial institutions, they have been traditionally conservative and the regulators have historically made sure their investment, liquidity and required surplus are conservative.
Still though, that didn't stop Manulife from over exposing their portfolio to equities and guaranteeing returns.....which is why they went from the insurer with the strongest balance sheet in the world 6 months ago to an insurer whose stock has fallen almost 50% in a week.
As for the financial institutions, they have been traditionally conservative and the regulators have historically made sure their investment, liquidity and required surplus are conservative.
Still though, that didn't stop Manulife from over exposing their portfolio to equities and guaranteeing returns.....which is why they went from the insurer with the strongest balance sheet in the world 6 months ago to an insurer whose stock has fallen almost 50% in a week.
Deaf Smith
Master of Arts
Health care is cheeper in Canada? Hahaha yea, if you don't mind waiting six months. The best doctors in Canada go to the U.S. Canada has British style health care, and thus the same faults.
Canada also lets the U.S. protect it. Thus it has a very small military.
Canada also has huge natural resources that have been untapped.
Canada's GNP for 205 was 1,052 billion
U.S. GNP for 2005 was 11,351 Billion. (but then who knows with Obama at the helm, Canada might overtake us!)
There is alot more to stats that stats.
Deaf
Canada also lets the U.S. protect it. Thus it has a very small military.
Canada also has huge natural resources that have been untapped.
Canada's GNP for 205 was 1,052 billion
U.S. GNP for 2005 was 11,351 Billion. (but then who knows with Obama at the helm, Canada might overtake us!)
There is alot more to stats that stats.
Deaf
Yet we seldom take the bold step of moving north...?
(Sorry couldn't resist)There's the rub. Health care can be excellent but how good is it really if its not accessible to those that are suffering?
Canada has built a fine health care system. However, there are more than just anecdotal mentions of patients not being able to get in to Canadian hospitals. I mean...y'all aren't exactly going to Buffalo for the weather...or because the Falls are prettier on our side :rofl:
Some folks say The Roswell Park Cancer Institute at the University of Buffalo is under contract from Ontario Cancer Care because Ontario cannot manage all of its patients. I don't know if that's true or not. Whether it is or isn't....Roswell Park gets so many Canadian patients they have a dedicated web site and online resources that are just for Canadian patients...
http://www.roswellpark.ca
http://www.roswellpark.org/files/1_2_1/pubs/PP/PP%20November%202008-CA.pdf
As do other hospitals in Buffalo
http://www.kaleidahealth.org/weightloss/canadian_patients.asp
There is this story about a neonatal intensive care units in St. Catherines being full, and a mother about to deliver twins a bit earlier than expected were re-routed to Buffalo Women and Children's...and the spokesperson for the hospital indicating this was more than just a one-time thing.
http://www.swampcrone.com/?m=200602
American hospitals are a backfill.
If America goes to a Canadian-style insurance plan...then who would backfill for America? :idunno:
If America goes to a Canadian-style insurance plan, then who would backfill for Canada?
This is what really gets me about the healthcare debate. A small, but very important part of what makes Canada's socialized medicine system work is.....the privatized U.S. health care system.
Its not a one-sided relationship either. Prescriptions are by far and away the most commonly used therapy in western medicine. When American insurance carriers scrimp by not offering prescription coverage (or when American patients scrimp by not buying coverage) there are many that turn to Canadian pharmacies to maintain their health. So, a small, but very important part of what makes the U.S. privatized health care system work is...Canada's socialized medicine.
I don't think we are growing in to two separate entities, I think we may be growing more interdependent as each of our systems gets more and more strained. Maybe one of these days our respective politicians may even find a way to solve health care problems together. :idea:
Call me crazy, but I thought people from Dublin were Irish citizens. I could certainly understand why they would not want to swear and oath to the Queen.
For me - I call it 'personal' because I know I can't explain it rationally in a way that makes sense to people not born in the USA. And it's not an attempt to show how much better the USA is or anything like that. But being born here and raised to believe we are citizens and never subjects, it gets in amongst ya. I was raised in the heartland, on God, guns, and grits. The swearing of an oath might be a non-event, something that one can just consider a formality and be done with it - I get that - but I can't do it. It may be in the DNA.
Gordon Nore
Senior Master
Yet we seldom take the bold step of moving north...?
I'm rubbing the pie off my face right now.
There are indeed. I firmly believe that we're failing to live up to our own good values in Canada. The fault is not in our stars, but ourselves.
Naw, it's the chicken wings at Jimmy Mac's. And we like the look of our Falls from your side.
Lies. All lies, I tell you. Roswell? Roswell? Area 51? Hello! No such thing. I've not heard that, and, if true, I'd like it to be all over our news and yours. Buffalo MRI advertises here. That's how I found my way to Lockport.
I accept your apology.
And you're welcome.
That is intriguing and quite logical. We can't work on issues like environment in isolation. For good or for ill, there is NAFTA. But if Canada and the USA are to be partners, we're on top.
Ramirez
Black Belt
That's not always be the advantage it may seem at times. I can't say that watching UFC has done me any real good, but I have picked up that much, at least.
Don't need the whole US. A Boy Scout troop and maybe a couple Marines looking for beer, take maybe a weekend. I nearly forced Montreal to its knees myself once, and that was just a visit to Rue de St Catherine looking for...uh...poutine.
Oh Canada!
Ramirez
Black Belt
I think you have just pointed out Canada's one great advantage over the US...the strip clubs.
Gordon Nore
Senior Master
I think you're right. My foggy brain has fudged details in haste. I probably had this conversation close to twenty years ago. Getting old.
You don't have to sell me, and I know little of God, guns, or grits. I'm simply averse to Monarchy. I think it has to do with my politics, and it's also probably generational. When I was growing up, Prince Charles was referred to as "the world's most eligible bachelor," and I thought, "Holy crap." Then it was published that Lady Diana had to take a virginity test to marry this guy (who had deflowered so many himself), and I opted out of the whole business.
Gordon Nore
Senior Master
One false move, buddy, and Alaska gets it.
No you didn't. Montreal was just drunk.
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