Next Pres. Election and Health Ins.

[mykidslovedogs]

I guess if I was diagnosed with a brain tumor, I would pay to go to The Mayo Clinic for my MRI and treatment. There are certain things where money is no object. But I would not want anyone claiming it is because I could not get it in Canada.

What if America had a single payor system and a shortage of specialists and MRIs for Brain Tumor diagnosis? Where would you go then? Sure, you could get it EVENTUALLY in Canada, but would it be too late?

Watch this video On The Fence Films :: Movies (a Short Course in Brain Surgery) about someone who needed a brain scan in Canada. He was placed on a long wait list, but didn't want to wait because of suspected cancer. He went to Buffalo to get his MRI (which showed cancer), yet Canada still wanted him to wait another 3 months for surgery. If he would have waited, he would have had incurable cancer. He went to the USA for surgery and spent a large sum of money to do that (could the average Canadian afford to leave Candada for brain surgery?). Canada refused to pay for the surgery because he didn't wait for permission which would have taken just as long as the wait for the surgery.

Single payor systems work WONDERFULLY for routine, preventive and acute care, but NOT SO WELL for complicated health problems requiring expensive diagnostics and the services of highly specialized doctors. Canada's system seems great to most people because MOST people don't need to have highly specialized care and don't experience dealing with the system for that purpose....but when they do need it, the tune changes...

Last year there was a net influx of doctors from the US because, after paying for the escalating malpractice insurance, they were netting less for the first time in decades. There are still areas underserviced. When my son moved his family to Belleville east of Toronto, it took a year to get a new family doctor there. This was four years ago. They used walk-in clinics but everyone likes to have a family doctor.

Was this an influx of specialists or primary care physicians? I doubt it was specialists, which, when it comes to major health problems, is what you really NEED!

The US system spends 17% of GDP on health care yet sees 50% of personal bankruptcies directly attributable to medical bills, and 47 million have no access at all. Canada spends 9% of GDP on health care and everybody has access to it.

I hate when people throw around these stats. We spend more on healthcare because we CAN. In Canada, prices are fixed, so it's not hard to put a limit on inflation. Our figures include the cost of care for people who leave other countries and get care in the USA when they can't get it in a timely manner in their own country.

Just because someone doesn't have health insurance doesn't mean they have no access to care. They can always pay out of pocket if they want to, and for routine care, it's not really that much more expensive to do that than health insurance itself. People in America will spend $20,000 on a new car, but when it comes to their own healthcare, they don't want to spend a dime.

Major medical insurance above a certain deductible is fairly inexpensive if you buy it BEFORE you get sick. Health insurance is most important for people with major medical problems. The great majority of uninsured people are not in urgent need of major medical services. I talk to people everyday who can easily afford a major medical plan but choose not to purchase it. That's their CHOICE. In fact a LARGE chunk of the uninsured population include people who CHOOSE not to buy it, even when they can afford it. Only a small percent of the uninsured are unwillingly uninsured AND in great need of expensive services (probably about 2-5%).

 

[Brat]

Ok, let's assume we don't have enough specialists to meet the need if everyone had insurance...

Will the rate of disease increase because more are insured If not, obviously there are a lot of people who NEED TREATMET TODAY who aren't receiving it because they can't pay for it.

 

[mykidslovedogs]

What would be your solution for those who have no insurance, or have insurance but could not afford the copay?

I say that it would be wonderful to give everyone the drugs they need for free, BUT, that would be idealistic. In the real world, there has to be some kind of rationing. In a single payor system, perhaps the unique drug for the rare health condition wouldn't be available to ANYONE. In America, the drug may be there but unaffordable to some. HOWEVER - At least in America, we have the ability to get it if we try hard. We can either work to pay for it if we are not disabled....we can turn to charitable organizations for help...we can get help from family and friends....we can get help from the gov't if we can qualify....we can save money in anticipation of future medical bills. In a system which places limitations on supply, there is no way to get around that.

 

[kcowan]

What if America had a single payor system and a shortage of specialists and MRIs for Brain Tumor diagnosis? Where would you go then? Sure, you could get it EVENTUALLY in Canada, but would it be too late?

I believe that The Mayo Clinic will always be a world class referral center no matter how badly the US messes up its health care system. I would go there because they do it a lot and see complex cases, not because of WAIT TIME.

 

[mykidslovedogs]

I believe that The Mayo Clinic will always be a world class referral center no matter how badly the US messes up its health care system. I would go there because they do it a lot and see complex cases, not because of WAIT TIME.

Well, IMO - I think that's wishful thinking. Why doesn't Canada doesn't have a "Mayo Clinic" with enough physicians to service everyone that wants care?

If the American gov't puts a cap on specialist's salaries (like Canada does - in order for the gov't to be able to afford to provide "free care for all"), how many young, intelligent and enthusiastic people will choose the spend the money, time and energy to become world class health care professionals?... Eventually, we will lose the talent that comes with Mayo Clinic style care, and then where will you go? Sure, maybe a few people will still choose those careers, but will there be enough of them to service the "unimited" demand? If not, who will have to wait for their care? You have to look at the LONG TERM consequences of switching to a single-payor system.

 

[kcowan]

If the American gov't puts a cap on specialist's salaries (like Canada does - in order for the gov't to be able to afford to provide "free care for all"), how many young, intelligent and enthusiastic people will choose the spend the money, time and energy to become world class health care professionals?... Eventually, we will lose the talent that comes with Mayo Clinic style care, and then where will you go? Sure, maybe a few people will still choose those careers, but will there be enough of them to service the "unimited" demand? If not, who will have to wait for their care? You have to look at the LONG TERM consequences of switching to a single-payor system.

Well this is a big IF. What I have learned when considering a move to the US was that the cost of liability insurance is going through the roof, and that this is already taking its toll on the desirability of going into the profession.

Even worse, it is encouraging some of the existing professionals to retire early because continuing to work is not that lucrative. One successful lawsuit that exceeds their coverage can ruin them financially.

We buy commercial health insurance every year to cover us when we travel (often) and so we are seeing some of the issues in the escalating costs of that insurance. Like any insurance, it is cheap when you are young and healthy.

 

[Brat]

Frankly I think it is a sin that physicians need to pay so much for their medical education, and I think interns and residents should earn a living wage. Assuming that physicians are actually paid promptly for almost all the care they provide they should be able to earn a reasonable living from services under the program. If a physician wants to provide care outside the program then so be it, but those higher earnings shouldn't be funded by tax supported tuition programs.

If physicians justify their fees because of their school loans then there could be school loan credits for services under a broader insurance program.

Insurers today negotiate fees with physicians, nothing new.

I agree that for many specialties liability insurance is an issue. As a culture we seem to think that it is a perfect world. Negligence needs to be proven, IMHO. Too many juries make awards because they feel bad for the person who has a poor outcome. On the other hand State medical societies aren't following up on complaints and supervision isn't all that it should be. In many ways they have handed off supervising to insurers . . to no one's benefit.

 

[mykidslovedogs]

Well this is a big IF. What I have learned when considering a move to the US was that the cost of liability insurance is going through the roof, and that this is already taking its toll on the desirability of going into the profession.

Even worse, it is encouraging some of the existing professionals to retire early because continuing to work is not that lucrative. One successful lawsuit that exceeds their coverage can ruin them financially.

We buy commercial health insurance every year to cover us when we travel (often) and so we are seeing some of the issues in the escalating costs of that insurance. Like any insurance, it is cheap when you are young and healthy.

You are correct - Malpractice insurance is a big problem here in the USA and one that needs to be addressed. Lawyers are always on the lookout to make money off of the system. In fact, they even ADVERTISE to people to come and find out if they are eligible to receive a settlement from class action lawsuits against pharmaceutical companies in particular.

On the other hand, please explain to me, then, why Canada does not have a Mayo Clinic. (Are you from Canada?).

 

[Webzter]

On the other hand, please explain to me, then, why Canada does not have a Mayo Clinic. (Are you from Canada?).

Is this potentially a straw man? Given that Rochester, MN actually makes it easy for Arabic speakers to get around (the downtown has many signs posted in English and Arabic), I think it's safe to say that the world feels that the Mayo Clinic is a pretty special place. After all, it's likely no faster to get from Saudi to the middle of Minnesota than it is to get to France, Spain, Germany, etc. But, to some degree, I wonder if they're the best simply because they're the best.

To expand on that, look at college football. The top college teams stay at the top for quite a while. I've heard, and it seems plausible, that this is because it's easier to get the best high school players to join a top-ranked team.

Or, look at Google, lots of smart computer nerds want to work there because lots of smart computer nerds work there.

I wonder if it's similar at the Mayo Clinic. Lots of smart medical people want to work there because lots of smart medical people work there. In other words, nothing attracts good talent like good talent.

(p.s. My wife and I used to get 100% coverage with any doctor in any specialty for $40 a month. Talk about a cool benefit)

 

[mykidslovedogs]

Is this potentially a straw man? Given that Rochester, MN actually makes it easy for Arabic speakers to get around (the downtown has many signs posted in English and Arabic), I think it's safe to say that the world feels that the Mayo Clinic is a pretty special place. After all, it's likely no faster to get from Saudi to the middle of Minnesota than it is to get to France, Spain, Germany, etc. But, to some degree, I wonder if they're the best simply because they're the best.

To expand on that, look at college football. The top college teams stay at the top for quite a while. I've heard, and it seems plausible, that this is because it's easier to get the best high school players to join a top-ranked team.

Or, look at Google, lots of smart computer nerds want to work there because lots of smart computer nerds work there.

I wonder if it's similar at the Mayo Clinic. Lots of smart medical people want to work there because lots of smart medical people work there. In other words, nothing attracts good talent like good talent.

(p.s. My wife and I used to get 100% coverage with any doctor in any specialty for $40 a month. Talk about a cool benefit)

IMO - America has Mayo because there is a profit motive

 

[FinallyRetired]

IMO - America has Mayo because there is a profit motive

That's a very sad commentary, and I refuse to accept that the only way to get world class science (and medicine is science) in our great country is through obscene profits.

In 1961 JFK challenged us to go to the moon, something dauntingly difficult. By 1969 we had achieved it. We didn't achieve it by offering huge profits to individuals of companies, but by appealing to their sense of challenge, of patriotism, and of scientific accomplishment. These were not profit-minded people making that dream come true, they were for the most part government workers and government contractors paid for through tax money. I put myself through college partly through that, doing analysis on the tractor transporter for the Apollo launch vehicle, and even though I was paid peanuts I would not have changed that job for the world. The opportunity to be associated even in a minor way with the leading edge of astronautics at the time, and providing service to our nation at the same time, was all I needed. I just can't accept that the leading physicians and biomedical researchers in this country will stop what they are doing and go into a new line of work because we don't pay what they demand. We're not talking poverty wages either, good researchers are at the top of the civil service scale in government.

 

[FinanceGeek]

Hey I'm off this thread for a day or two and WOW, lots of posts.

It is very clear to me from the various reports I've read that the Canadian system does a far better job than ours at providing universal access to most types of acute/routine care, but it comes at a substantial downside - far lower incentives for doctors and healthcare related companies to produce goods and services, and often substantial waiting periods for more complex and expensive care (some of which may not be harmful to the patient, but some of which certainly can be since its impossible to know ahead of time what you might find in any given scan/procedure).

A prior poster put it best, the goal is to improve the US system learning as much as we can from others' experience. I highly doubt a single payer system (with no private alternative) is coming to the US, when this was last brought up 15 or so years ago there was quickly an undercurrent of talk of setting up high end healthcare facilities on offshore oil drilling platforms or other sovereign territory such as Indian reservations, if necessary, to provide a private alternative.

A combined private/public system seems to be a decent mix. Perhaps the MA plan will be closer to the answer than either what Canada or US do today. Bravo to them for trying, even though its obvious that they won't get it all right on the first go. Time will produce more data.

 

[kcowan]

On the other hand, please explain to me, then, why Canada does not have a Mayo Clinic. (Are you from Canada?).

What Canada lacks is the extraordinary deep pockets of successful private investors. We don't have a Mayo Clinic for the same reasons that we don't have a Harvard, Yale or Stanford. This has nothing to do with government. The US is way ahead of Canada in tapping private benefactors for their "public" institutions. We are starting to get some momentum from the founders of eBay, RIM, and Celestica (Onyx). But we are way behind.

In fact, a major reason that my hospital, Vancouver General, has only 2 month lead times for major surgery is that the Pattison and Diamond families among others have been very generous.

 

[JustMeUC]

The talk of Canada's wait times mean little to me. I have had 3 MRI's over the years. Once I had a 10 week wait. Both other times the wait was well over a month. I had a accident and ended up having back surgery at Duke 2 years ago. They scheduled me almost 9 weeks out if I remember correctly and just fed me percocet in the meantime. Most everyone I have talked to has had similar wait times unless it is a true emergency.

I know someone personally who did not get chemo due to being uninsured but a homeowner and had small savings which put them out of the range for some of the free treatment but they certainly didn't have enough money to fund treatment. I suppose they could have sold thier house They had worked hard all their lives at a blue collar job but were not able to afford health insurance premiums. They passed recently at the relatively young age of 63. Would they be alive today had they had treatment? I don't know. Do we all have the "right" to cancer treatment? I don't know.

This topic is a little over my head in it's complexity but if I had a choice today I would choice Canada's system over ours. And this comes from someone who has great health insurance from their employer.

 

[kcowan]

A combined private/public system seems to be a decent mix. Perhaps the MA plan will be closer to the answer than either what Canada or US do today. Bravo to them for trying, even though its obvious that they won't get it all right on the first go. Time will produce more data.

The Canadian system started out as an experiment in one of our prairie provinces. I think there are ways to improve on it. That is the real potential for the current momentum. Don't trash the alternatives.
Take the best features of them and go world class. Leapfrog!

 

[Rich_by_the_Bay]

What Canada lacks is the extraordinary deep pockets of successful private investors. We don't have a Mayo Clinic for the same reasons that we don't have a Harvard, Yale or Stanford.

True, but you have a McGill, Royal Vic, McMaster, UBC, U. of Toronto and other world class places for health care and research.

Not bad.

 

[mykidslovedogs]

That's a very sad commentary, and I refuse to accept that the only way to get world class science (and medicine is science) in our great country is through obscene profits.

It's not the only way to get world class science/medicine, but, IMO, it is the only way to get world class science/medicine for the majority of people who WANT/NEED it in a timely manner - otherwise, there is not enough supply.

 

[mykidslovedogs]

What Canada lacks is the extraordinary deep pockets of successful private investors.

Why would that be? Could it be that the private investors don't see enough PROFIT in making the investment?....or are you just saying that the rich investors are being selfish for not freely giving their money away to a 'not so lucrative' cause.

 

[mykidslovedogs]

True, but you have a McGill, Royal Vic, McMaster, UBC, U. of Toronto and other world class places for health care and research.
Not bad.

I always see Canadians making comments that they will come to Mayo if they need to....why wouldn't they just use the above mentioned facilities instead?

 

[Martha]

There has been a fair amount of talk on this thread about importance of specialists and cutting edge treatment. There is some evidence that the number of specialists in an area does not lead to better care or improved outcomes. It does lead to more treatment though. I have linked to this article before in Dartmouth Medicine. I recommend reading it: Dartmouth Medicine Magazine :: The State of the Nation's Health

 

[Martha]

Another thought. I have a friend who got breast cancer 5 years ago. Her father was a retired Mayo surgeon. She discussed getting treated at Mayo and he saw no particularly strong reason for her to be treated there. The treatment protocols for her type of breast cancer are fairly standardized and the best treatment for her, and for most people, is treatment close to home.

I think we should be more worried about our primary care system in the United States than worried about keeping our specialists in the money.

 

[mykidslovedogs]

There has been a fair amount of talk on this thread about importance of specialists and cutting edge treatment. There is some evidence that the number of specialists in an area does not lead to better care or improved outcomes. It does lead to more treatment though. I have linked to this article before in Dartmouth Medicine. I recommend reading it: Dartmouth Medicine Magazine :: The State of the Nation's Health

I agree that cutting edge treatment doesn't always lead to better outcomes, but isn't it nice to know that it's there when it IS needed, and that you won't have to wait obscene amounts of time to get treatment? I mean, your everyday PCP isn't going to be able to diagnose and treat brain/breast/prostate cancer. Three months to get an MRI for diagnosing a brain tumor is a bit excessive (typical in Canada).

 

[mykidslovedogs]

I think we should be more worried about our primary care system in the United States than worried about keeping our specialists in the money.

Your point of view fascinates me. Primary care in our country is relatively cheap. In fact, in Denver, if you have a 5000 major medical plan, you are entitled to the network discounts for routine office visits, and the average discounted price is $40-$50 for a routine (PCP) office visit. School aged children can get $10-15 physicals at the local churches if their parents don't have health insurance.

It's interesting to me that you prefer free coverage for primary care vs. timely availability of treatment for serious illnesses.

 

[FinallyRetired]

It's not the only way to get world class science/medicine, but, IMO, it is the only way to get world class science/medicine for the majority of people who WANT/NEED it in a timely manner - otherwise, there is not enough supply.

Well, now, you've introduced an interesting though, supply and demand. Why is our health care cost continuing to rise well above inflation, and above people's abilities to pay? Because demand increases while supply stays the same or even deceases. IMO, there's several factors for this: an aging population, increased stress, increases in treatment options (ironically -- there was no MRI waiting list before there were MRIs), and a limited supply of physicians. We can't control many of these factors, but we can take steps to increase the supply of hospitals, equipment, and physicians. Since the private sector doesn't seem able to do this, there will be increasing pressure for the public sector to do it.

How many hospitals could be built with the money saved from reducing admin overhead from 30% (the private HMO number) to 3-5% (the Medicare number)? As far as physicians, one problem in producing more is that average med school cost is well over $30,000 per year, and it's very difficult to get into med school. Not that it should be easy to get into med school, not everyone can be a physician, but surely we could take steps to increase the supply.

To return to the Apollo program, I don't know how old you are, but when the Soviets put up Sputnik we were caught with our pants down. Not only were we behind in astronautics, we didn't have the engineers and scientists we needed to catch up. The answer was not to increase salaries and profits, but to produce more engineers through the National Defense education program (I was a product of that). Science, math, and engineering educations were subsidized by the government in return for an agreement to serve so many years either in the government or the military. In a few years we turned the situation around and became the world leader in aerospace. Why can't we do the same with medical education? Some say the AMA is partly responsible for throttling the demand, I don't know.

 

[Martha]

I agree that cutting edge treatment doesn't always lead to better outcomes, but isn't it nice to know that it's there when it IS needed, and that you won't have to wait obscene amounts of time to get treatment? I mean, your everyday PCP isn't going to be able to diagnose and treat brain/breast/prostate cancer. Three months to get an MRI for diagnosing a brain tumor is a bit excessive (typical in Canada).

If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.