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Old 02-03-2010, 11:15 PM   #21
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No, I'm not mad at Canada for expecting other countries to research and develop advanced medical procedures, so they can keep their costs low by exporting problem patients.
Did you really just write that Canada expects other countries to do advanced stuff so they (Canadians) can save money by exporting problem patients?

By the way, there were Banting and Best who basically discovered insulin. And McMaster University in Hamilton where evidence-based medicine was formalized, defined and brought to the rest of the world; and David Hubel, Nobel laureate for discoveries in vision and the brain. And a whole bunch more. Not bad for a country of 33mm.

Like the USA, Canada has a proud research legacy. Sorry.

Look, it is natural for anyone to judge a system for how it works for them as individuals, usually directly related to their wallet. But I have seen the systems both as an individual (it has worked well for me, albeit at great cost, currently about $16k per year) as well as a health worker.

Not a week goes by where someone I deal with didn't have their entire world profoundly shaken by sudden cancer, heart attack, stroke etc. which caused them to lose their job, insurance, huge chunks of their retirement savings, homes and more because they could not access or afford health insurance. Some of them are slackers, addicts, and the like, but most are not -- they are just out of luck, out of money and, in some cases, out of time. You just can't judge a system without looking beyond your own personal experience with it.

I believe in universal access to insurance, stopping pre-existing condition exclusions, and the untying of insurance from employment, all backed up by a federal safety net for those unable to pay due to impairment. As for the truly defiant bums, we're paying for them now anyway so we might as well cover them, too, with at least a hope of reforming one or two. Oh -- and a "public option" to keep the insurance companies honest would be nice, but I can live without it.
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Old 02-04-2010, 12:01 AM   #22
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RiT,
I wasn't trying to beliitle Canada's medical contributions at all,, but rather to point out a major flaw in their system. I lived in Spokane for many years, you would be shocked at how many Canadians came across the border for specialized procedures because they either could not wait or could not get the treatment they needed under their socialiized medical plan. Health care is the largest employer in Spokane, most of it driven by Canadians frustrated with a system that covers everyone and no one... And their Premier has to come here for an advanced procedure because their system either can't or won't provide for his treatment locally? As the OP said, makes you go hmmmm-right in the middle of the largest health care debacle debate in the history of this country.

I don't have the background in medicine that you have, but I do pay a lot of my hard-earned money in taxes and health insurance premiums that support a system that works so welll that people who get free health care at home choose to come here instead. 'nuf said.

Agree to disagree on this one?
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Old 02-04-2010, 07:49 AM   #23
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Agree to disagree on this one?
Of course. And I agree -- both systems have major challenges.

Here's to our continiued good health .
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Not just Canada...
Old 02-04-2010, 02:18 PM   #24
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Not just Canada...

It would appear that there are some medical care innovators among US insurance companies, too...

Insurers aim to save from overseas medical tourism - USATODAY.com

Until recently, most Americans traveling abroad for cheaper non-emergency medical care were either uninsured or wealthy. But the profile of medical tourists is changing. Now, they are more likely to be people covered by private insurers, which are looking to keep costs from spiraling out of control.

The four largest commercial U.S. health insurers — with enrollments totaling nearly 100 million people — have either launched pilot programs offering overseas travel or explored it. Several smaller insurers and brokers also have introduced travel options for hundreds of employers around the country.
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Old 02-04-2010, 03:39 PM   #25
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Rich in Tampa, that was a great post. Especially coming from someone in the business of health care (literally). My take on "universal health care is this" and you mentioned it Rich. The gvmnt could take 1/10 of the cost it's anticipating and just cover everyone that doesn't have healthcare. How you do this without pulling more and more people into that loop is beyond me. We as a country cannot deny them care. However, if I'm a billionair I ought to be able to buy the best care possible. That's the American way. Same as for the house you choose to live in or the car you drive. If you can afford an mulitmillion dollar home, go for it. Rolles Royce? You earned it. Doesn't mean everyone has the same right.
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Old 02-05-2010, 04:18 PM   #26
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Leaving the fact that a prominent Canadian has left the country to obtain health care in ours, I'll make one comment. His million dollar procedure is money US citizens are not spending, but is added to the per capita amount that US citizens spend on health care, further inflating the amount Americans appear to spend.
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Old 02-05-2010, 10:20 PM   #27
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His procedure is not available in England? Maybe too far to travel or problems with bumping someone from the wait list there?
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Old 02-06-2010, 10:39 AM   #28
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On the one hand, I want to keep an open mind until I know what procedure he had. If the procedure is available in Canada, even if Danny Williams had to go to another province, I would prefer that he had it in this country. If the procedure is not available in this country, maybe there's a reason. Not even a health system the size of Canada's can do everything for everybody. Outsourcing rare procedures is one way to avoid white elephants and underutilized services for zebra indications. Perhaps the market is the best way to match supply and demand for loss leaders.

On the other hand, Mr. Williams, while the Premier of Newfoundland and Labrador, is also a citizen and a multimillionaire. I guess he has the same rights as anyone else to make his own decisions.

It's unfortunate that being in the public eye practically requires politicians to explain their most private details, things that I personally think are nobody's business but their own. I feel sad, for example, that the leader of the federal New Democratic Party (a previously very fit and healthy guy) felt he had to have a press conference yesterday to announce that he has prostate cancer. TMI, IMHO!
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Old 02-07-2010, 12:08 AM   #29
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It would appear that there are some medical care innovators among US insurance companies, too...

Insurers aim to save from overseas medical tourism - USATODAY.com

Until recently, most Americans traveling abroad for cheaper non-emergency medical care were either uninsured or wealthy. But the profile of medical tourists is changing. Now, they are more likely to be people covered by private insurers, which are looking to keep costs from spiraling out of control.
It's ironic that the citizens of a country whose employer-based, pre-existing condition, health care plan has been repeatedly shoved in our faces as a shining model of "what works" can't get the care they need under their program.

This speaks volumes about America's health care system, and couldn't come at a better time.
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Old 02-07-2010, 09:20 AM   #30
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I do find it amazing that those of us that have quality (and very expensive) health care insurance think everything is just right...never looking beyond your own situation.

When the statement is made..."certainly we need to cover the uninsured but not as proposed"...it is never accompanied by any proposal that can get the job done. Truth is that many are just fine as we are...with many millions not insured for health care...and MANY more joining the ranks each day.

More of you may consider it a problem as your health care costs skyrocket...or you lose your coverage altogether. BTW...I personally have been fully insured since I was in college (40+ year ago)...but wife and I are now paying close to $13K per year (for a high deductible/out-of-pocket plan) as self employed...and increasing very rapidly.

My macro proposal would

1st Drop any pre-exisiting condition requirement from ALL medical insurance.

2nd Require insurance companies to provide "community" pricing where all coverage must be priced the same...wether you are a mega corp or a sole proprietor...maybe a small % addition for admin costs. Thus any buyer could shop the coverage and get identical pricing as large company w/o reagrd to pre-exisiting.

3rd Drop the cross state lines insurance buying restrictions

4th Establish a buying co-op that compares pricing and coverages from many/all commercial insurance companies from across the country...info only and NO gov plan.

5th Deal with the uninsured within the commercial insurance offerings...debate what subsidies/tax breaks to support purchase.

6th Establish long-term goals for coverage %...maybe ten years or so...to allow cost control, creativity and debate to play a factor.

Very macro and contemporaneous...but it is not "Canadian plan" but it does start "reform".

Don't gripe about other countries when many/most indutrialized countries outperform our health care system...when you consider the ENTIRE population...but certainly not for us with expensive plans...we are just fine...TomCat

FWIW...Tom Cat
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Old 02-07-2010, 09:41 AM   #31
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Tomcat,
What advantages do you see in people continuing to get their health insurance through their employer? And, how will we avoid sky-high premiums under your plan if we don't require that everyone buy insurance? If insurers have to insure all comers, and if the rates are the same for everyone, then it makes perfect sense to wait until you're sick or injured to buy insurance.
But, I agree with the overall approach you've outlined.
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Old 02-07-2010, 09:54 AM   #32
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Tomcat,
What advantages do you see in people continuing to get their health insurance through their employer? Perhaps making tax deductible with any means of purchase? My thought is it would be nearly impossible to "change" employer role...but it could evolve if you "equalized" with private purchase.And, how will we avoid sky-high premiums under your plan if we don't require that everyone buy insurance? If insurers have to insure all comers, and if the rates are the same for everyone, then it makes perfect sense to wait until you're sick or injured to buy insurance. Got me here...haven't figured out these two issues.
But, I agree with the overall approach you've outlined.
Great input...my primary impetus would be to "begin" the process of "reform". I do believe it is nearly impossible to get anything major through congress at this point...perhaps compromise will become more common when congress changes to more balanced in Nov 2010. I am a centrist and one fact I do not like is congress and presidency controlled by one party...no matter which one! TomCat
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Old 02-08-2010, 12:31 PM   #33
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I like the system here, too, because I am reasonably rich, employed, and healthy. For now.
The later being an absolute prerequisite for the former.
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Old 02-08-2010, 01:01 PM   #34
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My macro proposal would . . . .

1st Drop any pre-exisiting condition requirement from ALL medical insurance.

2nd Require insurance companies to provide "community" pricing

3rd Drop the cross state lines insurance buying restrictions
Requirements 1 & 2 are the primary reason why insurance costs differ so much between states. High cost New Jersey enforces 1 & 2 whereas low cost Texas does not. The entire "benefit" of point number 3 is that it circumvents the high cost requirements of 1 & 2. If 1 & 2 are universally applied throughout the U.S., point 3 will be of very little value.

There is no magic cost reduction to be had in allowing people to buy insurance across state lines. The savings come almost entirely from allowing insurance companies to deny coverage to sick people, which kind of defeats the purpose of health insurance.
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Old 02-08-2010, 01:12 PM   #35
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There is no magic cost reduction to be had in allowing people to buy insurance across state lines. The savings come almost entirely from allowing insurance companies to deny coverage to sick people, which kind of defeats the purpose of health insurance.
I don't know. Sometimes it comes because there are mandates that some states cover X while other states have no such mandate. In that case it would make sense for someone who has no reason to care about being covered for X to shop elsewhere, or else they are paying for mandated coverage that is of little to no concern to them.

Frankly this is a lot more complicated than simply "big bad insurance companies screwing people" -- which is a popular rallying point but is only one piece of a much bigger problem. And we do the issue (or constructive dialogue) little justice to look at it that way. Same as when some view tort reform as a magic bullet.
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Old 02-08-2010, 02:26 PM   #36
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There is no magic cost reduction to be had in allowing people to buy insurance across state lines. The savings come almost entirely from allowing insurance companies to deny coverage to sick people, which kind of defeats the purpose of health insurance.
Well, a company could decide to shop for states with the most favorable rules for their business model, and set up shop with that as their home state. That could improve the company's margins. It might not be the best for persons insured by that company, and would probably have little effect on the actual cost of medical services. (Cutting re-imbursement to doctors and hospitals typically results in fewer doctors or hospitals accepting that insurance. See UHC and their cutbacks a few years ago where many doctors, and Quest Diagnostics were not in their plan any more.)

I suspect that a simple rule to allow interstate insurance sales, with companies operating under the rules of their 'home state' would simply result in a race for the bottom, with a few states competing for the tax base insurance business by promulgating ever more favorable regulations.
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Old 02-08-2010, 06:54 PM   #37
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I don't know. Sometimes it comes because there are mandates that some states cover X while other states have no such mandate. In that case it would make sense for someone who has no reason to care about being covered for X to shop elsewhere, or else they are paying for mandated coverage that is of little to no concern to them.
Another term for that is "adverse selection". As in . . . I'm perfectly happy not having coverage for cancer, because I don't have cancer. My state doesn't mandate that my insurance company provide it, so I don't have it (and I might not even know I don't have that coverage, but boy is my insurance cheap). However, as soon as I get diagnosed, I'm going to sign up for that out-of-state plan where they have guaranteed issue laws and can't deny me coverage for pre-existing conditions.

You do realize that a system like that can't possibly work, right? The state with the least regulation ends up setting the rules for every other state. Any state that tries to mandate some higher level of coverage ends up getting swamped with sick people who aren't insurable in the other markets. Allowing people to buy insurance across state lines is nothing more than a back door way of deregulating the health insurance market. Which is what many of the supporters of this actually want. But if your goal is to make sure sick people have access to care, I don't see how this helps. The argument that it lowers costs so people can afford it is laughable because it only lowers costs for healthy people, but it does so at the expense of the sick who either pay more or go without insurance. Which is an ideal solution for those who never plan on getting sick.

But hey, that's how a free market for health insurance would work, so it must be the right thing to do (according to some).


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Frankly this is a lot more complicated than simply "big bad insurance companies screwing people"
I don't believe I said that. The point is, providing health care to sick people is expensive. So it logically follows that providing health insurance to sick people is going to be expensive. States with tough regulations force companies to bear the costs of insuring the sick, and those costs are reflected in higher rates. You can lower those rates by getting rid of the regulation but don't expect to get coverage for sick people that way.
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Old 02-10-2010, 02:44 PM   #38
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Here's an example that Premier Williams might do well to review.

Quote:
(CNN) -- Rep. John Murtha of Pennsylvania, a longtime fixture on the House subcommittee that oversees Pentagon spending, died after complications from gallbladder surgery, according to his office. He was 77.



The Democratic congressman recently underwent scheduled laparoscopic surgery at National Naval Medical Center in Bethesda, Maryland, to remove his gallbladder. The procedure was "routine minimally invasive surgery," but doctors "hit his intestines," a source close to the late congressman told CNN.
It is very sad and regrettable that Congressman Murtha passed away after this routine surgery. But, I'm sure that could happen at any hospital. The important thing isn't the medical result, but to take the deeper lesson from this. All of us, US and Canadian residents alike, need to just use the government-provided health care if it is available and not complain or seek any advantages that might come from private medical treatment.
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Old 02-10-2010, 03:10 PM   #39
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All of us, US and Canadian residents alike, need to just use the government-provided health care if it is available and not complain or seek any advantages that might come from private medical treatment.
Are you saying that government run health care killed John Murtha?
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Old 02-10-2010, 03:47 PM   #40
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Are you saying that government run health care killed John Murtha?
Well, yes, is there any doubt? It appears that the care he received at this government-run hospital did kill him. That's not to say this kind of thing doesn't frequently happen elsewhere, or that the health care was substandard, or that it was substandard because it was government-run. That would require a lot more analysis and evidence.
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