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Old 11-12-2015, 07:35 PM   #81
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Yes. From time to time we hear all sorts of stories about our health care system. Anything from you cannot select your own physician, specialist to substandard hospital care. Of course, none of it is factual.

I believe that much of the negative press is fueled by those who are probably making the most money. Health insurance companies, drug companies, hospital corporations, not to mention some in the medical professionals. All masked under a free enterprise or a "socialism is next to communism' tag line and complemented by half truths from other countries that have Government sponsored systems.

There is a lot of money at stake and by inference a good deal of funds available to politicians. We have been able to abate that to a certain degree by limiting the amount of political donations that can be made by corporations, unions, etc. Otherwise, I have no doubt that even more of our politicians would not have the public interest at the top of their priority list.
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Old 11-12-2015, 08:18 PM   #82
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I can see why people in those two categories like the ACA. I can also see why everyone else is pretty upset about it.

I guess unless we're starting wars or over-reacting to some perceived international slight there really "Ain't no 'we' "
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Old 11-12-2015, 08:24 PM   #83
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Old 11-12-2015, 08:28 PM   #84
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Originally Posted by rayinpenn View Post
The Who: Me 61, the Mrs 58, Daughter 21, Son16.
The story: Priced cost of similar ACA plan to the one I have with my employer. Roughly $2200 a month or over $26,000 a year. I am grand fathered into a plan at work where they will pay a portion- cost to me $1750 a month or $21,000 per year. I guess it will drop when I hit 65 or daughter graduates and gets a job with her own insurance. When I tell the aforementioned to my younger buddies in the office they say "$2200 a year?" I tell that it is a month. They say OMG...
Wow!

Out of curiosity, I entered in the above data for a family of 4 to see what it costs where I live. Sure enough, the highest premium is $2229/month for a Gold HMO policy, $2000 deductible. The lowest premium is a Bronze HMO plan for $882/month, $12,300 deductible.

Pre-ACA, we had a family policy like the above Bronze, but PPO and with a deductible of $10K for the entire family of 4. We paid around $600, but this was 6 years ago. Then, we dropped our daughter when she started work, and the premium dropped perhaps $75, then increased next year to the same amount. Then, we dropped our son when he flew the nest, and the same thing happened. The yearly increase was such that we ended up paying the same for 2 as we did initially for 4. Premium for youngsters is not that bad though, because statistically they are rarely sick.
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Old 11-12-2015, 08:32 PM   #85
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I would think the costs of medical education and after-school training is one reason for our high costs. I've heard it's much cheaper elsewhere, or at least subsidized. So we're supporting a bunch of medical colleges.

And then we have the regulatory agencies that add plenty of cost, just for us, for both drugs and medical devices.

Not sure either of those show up directly in cost studies.
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Old 11-12-2015, 08:43 PM   #86
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Brett - the issue I've always heard with Canada is that wait times can be quite long. E.g., see Medical specialist wait times longer than thought: study | Toronto Star

and

https://secure.cihi.ca/free_products...pproved_EN.pdf

When I moved to the US and needed to use the emergency room I was astounded that there was no wait and I was seen right away. My wife on either employer or ACA health plans has always been able to get in and see a specialist immediately. She has also gotten MRI's done within a day or two of the doctor ordering it. In contrast the second link says " the typical wait (50th percentile) for an MRI scan in 2014 ranged from 29 to 82 days" (in Canada for 5 provinces that report it).

I think overall studies tend to show that Canada has comparable or better overall outcomes, but I've not seen a study that looked at outcomes for the subset of people in the US with good insurance.

On the other hand, perhaps wait times in the US will be increasing as well for people on exchange plans if networks begin to narrow/continue to narrow.
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Old 11-12-2015, 09:16 PM   #87
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> I've heard it's much cheaper elsewhere, or at least subsidized

Subsidizing something doesn't really lower it's costs. It just moves them around.
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Old 11-12-2015, 09:51 PM   #88
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> I've heard it's much cheaper elsewhere, or at least subsidized

Subsidizing something doesn't really lower it's costs. It just moves them around.
Yes. If you are not left holding the "hot potato", then it's cheap for you.
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Old 11-12-2015, 10:34 PM   #89
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I don't know if there are any Western European readers of this forum but I personally would love to hear first hand accounts from folks that have actual real experience with the health system in those countries. Reason for my question is that there's got to be something better than the crazy system we got here in the USA and there is so much smoke being blown @ these shores that the only thing I would trust is first person accounts.
We have many relatives in the UK that have excellent results from the healthcare there at no out of pocket costs, and minimum to zero waiting times depending on seriousness of condition. The following list is some of the very successful procedures they have gone through this past 10 years.

Brain surgery to remove a non-malignant tumor (day after it was discovered by MRI)
2 knee replacements (MIL while in her 70's)
Heart valve replacement.
Pacemaker
Hysterectomy to remove cancer (this was my sister 7 years ago, declared free of cancer 5 years ago)
Kidney replacement, only 5 weeks on donor waiting list.
Hernia in groin, my dad had to wait 4 weeks after diagnosis. He was age 76.

We will be moving back to England next year and can report 1st hand after that. I do know that prescriptions for those that have to pay is fixed at ~$12 per refill. Many pay nothing for prescriptions including children and according to the government website 90% of prescriptions are free.

https://www.gov.uk/government/speech...rom-april-2015
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Old 11-13-2015, 07:45 AM   #90
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Brett - the issue I've always heard with Canada is that wait times can be quite long. E.g., see Medical specialist wait times longer than thought: study | Toronto Star

and

https://secure.cihi.ca/free_products...pproved_EN.pdf

When I moved to the US and needed to use the emergency room I was astounded that there was no wait and I was seen right away. My wife on either employer or ACA health plans has always been able to get in and see a specialist immediately. She has also gotten MRI's done within a day or two of the doctor ordering it. In contrast the second link says " the typical wait (50th percentile) for an MRI scan in 2014 ranged from 29 to 82 days" (in Canada for 5 provinces that report it).

I think overall studies tend to show that Canada has comparable or better overall outcomes, but I've not seen a study that looked at outcomes for the subset of people in the US with good insurance.

On the other hand, perhaps wait times in the US will be increasing as well for people on exchange plans if networks begin to narrow/continue to narrow.
I think it depends on your insurance, geographic area, etc.

With Kaiser - they kind of triage the appointment times for specialists and imaging. Emergency/acute gets in faster.
My father, when they were figuring out his multiple myeloma, got in to see various specialists within days... My husband got in to see his cardiologist very quickly. My kids were able to get appointments with orthopedics, facial surgeons, opthomologists with no waits. If I want to see a dermatologist - I have to wait a few weeks. My brother, who had a history of melanoma, got in much quicker if he had a mole.

Wait time for a routine mammogram appt is closer to 2 weeks. I would imagine if it's a follow up to something seen or felt in a breast exam - the wait time would drop.

I think that's a reasonable approach.
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Old 11-13-2015, 08:11 AM   #91
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I would think the costs of medical education and after-school training is one reason for our high costs. I've heard it's much cheaper elsewhere, or at least subsidized. So we're supporting a bunch of medical colleges.

And then we have the regulatory agencies that add plenty of cost, just for us, for both drugs and medical devices.

Not sure either of those show up directly in cost studies.
I think the temptation is to try to find the cause when the problem is many issues that systemically drive up costs. My experience is in the auto industry, particularity in struggling with quality. Initially there was the search for the cause. It was the factory assembler's fault. It was the suppliers' fault. It was nit picky customers. It was Consumer Reports picking on us. It was the government's fault for setting emission and safety regulations. But until there was sufficient pressure to quit making superficial efforts (like imitating Japanese calisthenics for line workers) and to do a thorough analysis of every single step and process, that progress started to be made.

Some medical systems have started taking cost containment seriously, but for the most part, I see an inefficient, disjointed machine that charges what it wants because their leverage is so great and competition is so weak.
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Old 11-13-2015, 08:25 AM   #92
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I haven't had a similar experience than OP. My group insurance was $215/pp with the employer paying something above that but it was considerably higher than megacorp but our employee base was a lot 50+ males. I went out and bought a policy, no subsidy, for $265...which if the company was paying even 20%, my individual plan was as cheap or cheaper than the group plan.

2016 I won't be working so can take advantage of subsidies, and my plan went up about 20%, assume some is based on age and some for inflation which I expected.

I do think one of the major impacts people are seeing is that when your on a company plan, it was usually single and family plan.. that was it, so all families paid the same price thus they cost shared; however in the marketplace insurance you pay PER KID. That is a huge change, so having more kids all of a sudden becomes much more costly. ie so even though you can leave your 24 yo stay on your insurance plan.. its not "free" by any means unlike group plans.
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Old 11-13-2015, 09:40 AM   #93
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I think it depends on your insurance, geographic area, etc.

With Kaiser - they kind of triage the appointment times for specialists and imaging. Emergency/acute gets in faster.
I agree that triaging is entirely sensible and I expect it to occur. Some of the times we were able to specialists immediately was probably due to bumping others down the list. I guess the issue I'm concerned with in Canada (and ACA with narrowing networks) is whether wait times are systematically too long to the point where it affects quality of care.

Quote:
If I want to see a dermatologist - I have to wait a few weeks. My brother, who had a history of melanoma, got in much quicker if he had a mole.
A few weeks for a non-urgent care is longer than I would personally like, but I wouldn't be too concerned. However in Canada dermatology wait times is measured in months:

Quote:
half of Ontarians wait at least three months for a first visit with a dermatologist, and one-quarter of patients wait six months or more for an appointment.
from http://www.dermatology.ca/wp-content...PT-2013-EN.pdf


Quote:
Across Canada, half of all patients wait longer than 12 weeks for a routine appointment with a dermatologist following referral from their family doctor. Shockingly, less-than-acceptable wait times apply even to appointments to investigate a possible diagnosis of skin cancer. In 2011, the Melanoma Network of Canada reported that 55 per cent of patients had to wait longer than the accepted benchmark of two weeks to be seen by a dermatologist.
from http://www.dermatology.ca/wp-content...PT-2013-EN.pdf


In addition, I don't like that the urgency is probably determined by the family doctor who is not a specialist and is more likely to make errors. More than once, we've experienced general practitioners who were way out of their comfort zone and this is one reason why we strongly prefer a PPO plan.
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Old 11-13-2015, 09:58 AM   #94
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Wait times can be unacceptable in Canada. They vary by province since our medicare plan is managed by the province, not the country. Also depends on the hospital, and the service. It is a hot issue in most jurisdictions.

We have experienced very good service but we know others who have resorted to paying for a private MRI.

Our heath care system in Canada has challenges, problems. But the bottom line is that it is universal and if you are ill you will be taken care of without anyone searching through your wallet as it were.
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Old 11-13-2015, 10:05 AM   #95
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I think the temptation is to try to find the cause when the problem is many issues that systemically drive up costs. My experience is in the auto industry, particularity in struggling with quality. Initially there was the search for the cause. It was the factory assembler's fault. It was the suppliers' fault. It was nit picky customers. It was Consumer Reports picking on us. It was the government's fault for setting emission and safety regulations. But until there was sufficient pressure to quit making superficial efforts (like imitating Japanese calisthenics for line workers) and to do a thorough analysis of every single step and process, that progress started to be made.

Some medical systems have started taking cost containment seriously, but for the most part, I see an inefficient, disjointed machine that charges what it wants because their leverage is so great and competition is so weak.
Stephen Brill wrote a great article on heath care costs in the U.S. for Time, called Bitter Pill: Why Medical Bills Are Killing Us

Bitter Pill: Why Medical Bills Are Killing Us - TIME

"Over the past few decades, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we’ve squeezed the doctors who don’t own their own clinics, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. And of course, we’ve squeezed everyone outside the system who gets stuck with the bills.

We’ve created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract."
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Old 11-13-2015, 10:16 AM   #96
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But the bottom line is that it is universal and if you are ill you will be taken care of without anyone searching through your wallet as it were.
Overall I prefer the Canadian system over US. Even with ACA I have 1/4 of my stash allocated to healthcare and I'm worried I'm underbudgeting. With that amount, I could just move back to Canada and buy a second home in the US to escape the winter.
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Old 11-13-2015, 11:53 AM   #97
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I see several comments about costs. The consumer is part of the problem.


Diet (type of food, quantity)
Exercise, lack of (they are working on an exercise pill, you pop the pill and skip the exercise, made for America)
Pill popping, nobody thinks about long term side effects
Freedom, not accepting options like HMOs which try to control costs

I find it amazing that we are willing to spend on drugs but we are not willing to make changes that might reduce the need for these drugs or doctor/hospital visits.

DISCLAIMER: I accept that many issues cannot be solved with changes in habits.
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Old 11-13-2015, 12:21 PM   #98
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I see several comments about costs. The consumer is part of the problem.


Diet (type of food, quantity)
Exercise, lack of (they are working on an exercise pill, you pop the pill and skip the exercise, made for America)
Pill popping, nobody thinks about long term side effects
Freedom, not accepting options like HMOs which try to control costs

I find it amazing that we are willing to spend on drugs but we are not willing to make changes that might reduce the need for these drugs or doctor/hospital visits.

DISCLAIMER: I accept that many issues cannot be solved with changes in habits.
Very valid point. I recently lost weight thanks to cleaning up our diet, exercise too. When he asked me about some of the prescriptions I had been on he appeared dumbfounded that I no longer wanted them. No doc, it took me months of not sleeping to get off of Ambian, I'm not taking any more!

Since doing that I no longer have symptoms of or take medicine to control:
Tachycardia
Hypertension
Triglycerides
GERD
Insomnia

DW has had similar sucess. Not a bad trade off in my mind!
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Old 11-13-2015, 01:22 PM   #99
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Originally Posted by DEC-1982 View Post
I see several comments about costs. The consumer is part of the problem.

Diet (type of food, quantity)
Exercise, lack of (they are working on an exercise pill, you pop the pill and skip the exercise, made for America)
Pill popping, nobody thinks about long term side effects
Freedom, not accepting options like HMOs which try to control costs

I find it amazing that we are willing to spend on drugs but we are not willing to make changes that might reduce the need for these drugs or doctor/hospital visits.

DISCLAIMER: I accept that many issues cannot be solved with changes in habits.
I agree- the point that really drove this home was when someone noted that the reason insurance was so expensive was that companies were no longer permitted to restrict or deny coverage due to pre-existing conditions. That's a blessing, of course- nearly all of us have one or more things that could make it hard to obtain coverage. (In my case, I consider myself to be in perfect health, but I have borderline high cholesterol, have had a couple of benign intestinal polyps removed and also had a benign breast lump removed when I was 18.)

But then I think of all my HS classmates on FB who joke about what awful shape they're in and blame it on age, or menopause, or weight they haven't been able to lose since they had the kids (the youngest kid being 30), and who post really awful recipes with sour cream, four kinds of cheese and bacon, and I realize I'm paying for the consequences.

My former employer had a wellness program and I got 50% off my share of the health insurance premiums for workouts, staying within normal weight, not smoking, good results on a cardiac step test, etc. Maybe private insurers should be allowed to give discounts for healthy habits!
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Old 11-13-2015, 02:56 PM   #100
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I agree that triaging is entirely sensible and I expect it to occur. Some of the times we were able to specialists immediately was probably due to bumping others down the list. I guess the issue I'm concerned with in Canada (and ACA with narrowing networks) is whether wait times are systematically too long to the point where it affects quality of care.



A few weeks for a non-urgent care is longer than I would personally like, but I wouldn't be too concerned. However in Canada dermatology wait times is measured in months:


from http://www.dermatology.ca/wp-content...PT-2013-EN.pdf



from http://www.dermatology.ca/wp-content...PT-2013-EN.pdf


In addition, I don't like that the urgency is probably determined by the family doctor who is not a specialist and is more likely to make errors. More than once, we've experienced general practitioners who were way out of their comfort zone and this is one reason why we strongly prefer a PPO plan.
Even with a PPO dermatologist appointment wait times can be 3 months in my part of the U.S.
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