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Old 09-27-2007, 04:10 PM   #21
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I can believe malpractice has an effect. In 1976 we had a friend that left the Air Force to go into private practice OB in Montanna. He was going to get $200,000 for his first year, but had to pay $100,000 is malpractice.
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Old 09-28-2007, 11:24 PM   #22
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I would highly recommend a new Michael Moore documentary, called "Sicko." Michael interviews many people in Canada, England and the U.S. about health care. It's truly a shame that the U.S. being the richest country in the world has 47 million of its 300 million citizens without health insurance. When these 47 million people seek care in the emergency wards of our hospitals, the rest of us end up paying for it in terms of higher insurance premiums. When 1 out of every 6 Americans is without health insurance, we all end up paying for them anyway. Emergency room care is many more times expensive than is care in a doctor's office.
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Old 09-29-2007, 05:51 AM   #23
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I would highly recommend a new Michael Moore documentary, called "Sicko." Michael interviews many people in Canada, England and the U.S. about health care. It's truly a shame that the U.S. being the richest country in the world has 47 million of its 300 million citizens without health insurance. When these 47 million people seek care in the emergency wards of our hospitals, the rest of us end up paying for it in terms of higher insurance premiums. When 1 out of every 6 Americans is without health insurance, we all end up paying for them anyway. Emergency room care is many more times expensive than is care in a doctor's office.
Yes it is true many of these people do not pay their bills, however a large number of the people quoted as not having health insurance do pay their medical bills on a payment plan. I have only heard of one hospital not willing to accept a very generous payment plan and actually that was a collection agency. The numbers also do not site how many people have access to medical insurance, but willingly choose not to purchase it. To characterize those who do not have insurance as people who can not afford decent health care I think is more than a little disingenuous.

My sister does not have health insurance, not because she cannot afford it, but because she chooses not to purchase it. I think she is foolish. When I attempted to find out why she opted out of purchasing it, her logic went like this: I used to work for an insurance company and they overcharge for everything. I'm not giving them money for something I can afford to pay myself. She and her family do go in for periodic check ups and they pay for it all out of pocket, normally less than $100.00 per visit. They are relatively young and if you think about it, unless you have a serious medical issue, when you are young about the only time you did go to the doctor was for emergency medicine. They really don't have much money to begin with, so I guess if something major happened they would be going to see the bankruptcy lawyer to pay their medical bills.

I've often wondered does the 47 million often quoted also include the roughly 12 million illegal immigrants? Does Canada provide health insurance to illegal immigrants?
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Old 09-29-2007, 10:27 AM   #24
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In looking for a better picture of the 47 million uninsured I came across the following.

Census: Uninsured Can Afford It

It does paint a different picture than often quoted. Personal responsibility seems to play heavy on the number.
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Old 09-29-2007, 10:47 AM   #25
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in terms of the waits in Canada - is it because there aren't enough doctors in the workforce there - or because this is the level of care the system can afford? ie if there was a way to encourage more people to be doctors in Canada, would that help the situation - and/or do they not get paid well enough for their trouble to become a doctor?

in my work we evaluate workforce a lot for various things like public education, child care etc...so i'm just curious what affect that plays into the canada scenario.
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Old 09-29-2007, 12:01 PM   #26
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There is definitely delays in getting to see doctors for routine care. This is partly caused the system rationing the number of referrals and tests for discretionary tests. An example is my recent colonoscopy. It was booked by my doctor in March and I waited until July. There was no evidence in the occult tests to suggest it was necessary. Had it been an emergency, I could have got in within a day or two.

Because there are no extra charges for these procedures beyond the cost of health insurance, demand is high and this leads to rationing. A friend who was diagnosed with colon cancer got his surgery and chemo therapy right away.

Is it perfect? No way. In some rural areas, people have difficulty getting a new family doctor. There are walk-in clinics that handle these cases and other non-urgent matters like earaches, reliving demand on hospital emergency wards. Some form of copay would discourage people from using their doctor for colds and the flu, using time that a new family could use.
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Old 09-29-2007, 12:04 PM   #27
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...and/or do they not get paid well enough for their trouble to become a doctor?
There is growing evidence that Canadian doctors take home as much pay an US ones because they don't have expensive liability insurance. The brain drain has reversed in recent years with some doctors returning home.
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Old 09-29-2007, 06:50 PM   #28
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thx for the 411 kcowan...
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Old 09-29-2007, 09:02 PM   #29
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There is growing evidence that Canadian doctors take home as much pay an US ones because they don't have expensive liability insurance. The brain drain has reversed in recent years with some doctors returning home.
Here is the fee schedule from the Canadian Medical Protection Association. They vary with the type of work a physician does and where he or she works (some provinces are more litigious than others). The highest fee is for obstetricians in Ontario ($55,764). For comparison, also attached are the new fees (effective October 1) for obstetric care in Ontario. A physician gets paid $61 for a major prenatal visit and $445.75 to deliver a baby vaginally. In other words, in Ontario, an OB must deliver 125 babies per year to cover the cost of insurance. That's before taxes are accounted for. To be fair, in most provinces, the medical association has negotiated partial rebates.

Canada currently has a shortage of physicians principally because of poor manpower planning in the 1990s. But this is not the only reason why we have waiting times. Many wait time problems are due to processes with many steps having a bottleneck. Innovative groups are now applying operations management science to this problem. Many emergency waits are due to shortages of family doctors: people who don't need to go to the emergency room. do. And then there's the question of how many people on waiting lists for surgery really need the surgery? Without a centralized waiting list, a patient may be on several surgeon's waiting lists. I could go on, but I won't.
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Old 09-30-2007, 05:55 AM   #30
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In looking for a better picture of the 47 million uninsured I came across the following.

Census: Uninsured Can Afford It

It does paint a different picture than often quoted. Personal responsibility seems to play heavy on the number.
Any insurance type program (pooling of money)... privately managed or by the government... will have to be compulsory. Otherwise, it is subject to being gamed.
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Old 10-02-2007, 11:05 PM   #31
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Kcowan:
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An example is my recent colonoscopy. It was booked by my doctor in March and I waited until July. There was no evidence in the occult tests to suggest it was necessary. Had it been an emergency, I could have got in within a day or two. ...A friend who was diagnosed with colon cancer got his surgery and chemo therapy right away.
Hi Kcowan, Glad your tests came back clear.

It's my understanding that once bleeding begins to show in the stool, one already has the problem (of cancer). Getting rid of any polyps before they begin bleeding is the way to prevent colon cancer, not waiting until there is occult blood in the stool to find out if we might have it. Colon cancer is 100% preventable.

I don't know why the occult blood tests are still relied upon so heavily as a 'guarantee' that there is no cancer present.

Perhaps I am more nervous about this since my mother died of colon cancer and I would not want to wait 5 months for a test. I schedule them regularly as recommended by my doctors.

For what it's worth, the last 4 of the Interviews we have done with successful Early Retirees, none of them had health insurance. One of the interviews was with Lance, a forum member here.

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Old 10-03-2007, 12:56 AM   #32
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Canada currently has a shortage of physicians principally because of poor manpower planning in the 1990s.
I'll risk being politically incorrect and suggest another reason. Many male physicians work long hours to maximize income. Many, but not all, female physicians reduce their hours, especially if they have children. I believe today, >50% of graduating doctors are female.

Canada may not have provided enough seats in med school because the 'powers that be' did not assume physicians would want to work a reduced schedule.
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Old 10-03-2007, 12:36 PM   #33
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Kcowan:
Hi Kcowan, Glad your tests came back clear.

It's my understanding that once bleeding begins to show in the stool, one already has the problem (of cancer). Getting rid of any polyps before they begin bleeding is the way to prevent colon cancer, not waiting until there is occult blood in the stool to find out if we might have it. Colon cancer is 100% preventable.

I don't know why the occult blood tests are still relied upon so heavily as a 'guarantee' that there is no cancer present.

Perhaps I am more nervous about this since my mother died of colon cancer and I would not want to wait 5 months for a test. I schedule them regularly as recommended by my doctors.

For what it's worth, the last 4 of the Interviews we have done with successful Early Retirees, none of them had health insurance. One of the interviews was with Lance, a forum member here.

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I believe the occult tests are used because blood is an indicator of a colon problem. not that clear indicates clear. My point was that I demanded a colonoscopy and got it but, because it was not the doctor's idea, I waited from March until July.

I demanded it because a friend has colon cancer. And he said that he thinks anyone over 45 who does not have a colonoscopy is crazy.
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Old 10-03-2007, 06:43 PM   #34
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I'll risk being politically incorrect and suggest another reason. Many male physicians work long hours to maximize income. Many, but not all, female physicians reduce their hours, especially if they have children. I believe today, >50% of graduating doctors are female.

Canada may not have provided enough seats in med school because the 'powers that be' did not assume physicians would want to work a reduced schedule.
True. The manpower planners did not take that into account.
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Old 10-03-2007, 09:38 PM   #35
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I believe the occult tests are used because blood is an indicator of a colon problem.
Exactly. We’re on the same page here. However, once a person has blood in the stool, then they already have the polyps that are bleeding. Better to have the colonoscopy as a preventative measure than to wait until there are polyps in the colon, and there is blood in the stool.
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My point was that I demanded a colonoscopy and got it but, because it was not the doctor's idea, I waited from March until July.
I understand. Glad you demanded a test. (Too bad that you had to ‘demand’) Sorry, too, that you had to wait so long! Personally, I think that is unconscionable.

If you had wanted your brakes changed, your taxes done or your house painted, I doubt that any of those businesses would have had you wait 5 months. That is bad business, in my opinion. If you had to have waited for these other services, you would have gone elsewhere. That, also, is my point. That particular medical system dicourages you to go elsewhere. (IMO)

I had colonoscopies done both in Mexico and in Thailand. Scheduled the appointment the day before. The morning of the appointment I drank Swiff (You get the idea from the name…) at 5 am, and my appointment was at 8 am. Had a courtesy ambulance take me home (included in the $500 price) and both countries gave me videos of the procedure to show the next doc the next time.

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I demanded it because a friend has colon cancer. And he said that he thinks anyone over 45 who does not have a colonoscopy is crazy.
Again, we are on the same page. I don’t know if I would say ‘crazy’ but certainly they are unaware. Colon cancer is 100% preventable.

Thanks, Kcowan. I'm glad you had the common sense to get tested.

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Old 10-04-2007, 03:26 PM   #36
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...both countries gave me videos of the procedure to show the next doc the next time.

Again, we are on the same page....
Now that is another pet peeve of mine. When we paid for the virtual colonoscopy for DW, we got a DVD of the whole thing including their analysis and conclusions, but in the our regular system, we get nothing.

I get our annual blood tests and run a spreadsheet with the results and trends (because the doctor just uses a visual scan) so I have taken some control but no videos are even offered.

I have to admit that there is a huge opportunity for improvement, particularly in getting people to take personal responsibility for their own health...
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Old 10-04-2007, 10:05 PM   #37
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I have to admit that there is a huge opportunity for improvement, particularly in getting people to take personal responsibility for their own health...
I agree completely. However, the question is.. how does anyong "get" another to do something?

It would seem we would be motivated since it is our own health, but that is not the case.

Financial discounts or other incentives might work... but government being what it is, "punitive" incentives will probably be tried first (like the taxes on alcohol and cigarettes, etc. are now - and you can see how that doesn't really work...) instead of discounts on insurance fees for exercise programs and non smoking -- although I hear that some insurance companies (like Blue Cross?) give you these incentives to join a gym, a nutrition class, and for being a non smoker... am I wrong here?

What ideas might you have Kcowan... anything?

I am quite curious about this topic..

Thanks for your time.

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Old 10-05-2007, 01:41 PM   #38
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In the October 2007 issue of CARP (admittedly biassed), they quote Dr Arnold Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School:
Quote:
Canadians should beware the consequences of a US-style, market-oriented, fragmented health insurance system which results in uncontrollable costs, lack of access, and inequality.
He goes on to advise Canadians that the market does not work well for certain aspects of our lives such as education, environment, health care and public safety. This is in the context of how we need to change our system to improve access.

IMHO efficiency, fairness are not attributes I associate with government. However, our doctors are entrepreneurs, and hospitals are built/enhanced with private funds. So the capacity is there. What seems to be missing is a system for finding open slots for referrals to specialists. The doctors don't get compensated for finding early slots in referrals so there is no financial motivation for them trying to find a timely appointment.
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Old 10-05-2007, 09:59 PM   #39
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Canadians should beware the consequences of a US-style, market-oriented, fragmented health insurance system which results in uncontrollable costs, lack of access, and inequality.
But our health care system is not market oriented…

It is based on guaranteed payments by a 3rd party (the insurance companies) and insurance is provided (guaranteed) by the employer.

This series of guarantees instills a certain kind of ‘market laziness’ in the consumer. They don’t go looking for the best prices because they don’t have to. The consumer isn’t that concerned about the prices of a procedure because they don’t directly pay for them.

The consumer is concerned about the price of his premium. That’s a big difference…

And since the procedures themselves are not open to the free market price, there is no competition to bring that price down. Since the payments for those procedures are guaranteed by the insurance company, there is rampant fiscal mismanagement. This is partially what drives the prices of the premiums up. This, of course, and all the illegals and uninsured who don’t pay their bills…

Quote:
He goes on to advise Canadians that the market does not work well for certain aspects of our lives such as education, environment, health care and public safety. This is in the context of how we need to change our system to improve access.
I disagree again. He is lumping in public safety - surely a feature that needs to be provided for by government - along with the assumption that health care should be provided for by the government, when his premise (above) (IMO) is wrong to begin with.

Education would do well if it were left more open to other ways of payment. Public schools are good in some areas, but there are lots of people who would prefer to send their kids to private institutions and do so.

Yes, our health care system is fragmented and has outrageous costs, but it is not because it is market oriented. It is the exact opposite.

Can’t believe he said that… Just because he is a doctor, doesn't mean he knows anything about business...

Would you assume that just because he is a doctor and knows bodies, chemistry, and so on, that he also knows how to fix an air conditioner? or run a school, or write a novel or fly an airplane or..

I mean the man is knowledgable about his field. That doesn't necessarily translate to other fields... I'm sorry I just can't give him that. And his answer about market forces reveals that he doesn't know what he's talking about.

We as consumers have to digest and weigh what we read and what we are being fed in the media.

Thanks for posting, Kcowan. I'll unbunch my underwear in a minute!

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Old 10-06-2007, 06:21 AM   #40
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Billy good post. So how would you suggest fixing the health care system?
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