Why does health insurance vary state to state

[Martha]

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Originally Posted by FIRE'd@51 HIPAA is better than nothing, but it is of no help on the cost side. We recently had a thread about a 50-yr old woman in NC who developed breast cancer while on COBRA. HIPAA would guarantee her access to insurance, at over $2000 per month.

Yes, HIPAA does not regulate cost at all. Also, the lifetime limits or limit per illness or per year can be low. Look at Mississippi. Or South Carolina.

[FIRE'd@51]

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Originally Posted by mykidslovedogs I have no control over state or federal regulation, which is typically the cause of reputable carriers, like Mutual of Omaha, being driven out of the individual health insurance market.

This is exactly my point. And you have no way of knowing for sure that all the people to whom you are recommending Assurant (or any other carrier) won't end up exiting the individual insurance market for exactly the same reason.

Will you then say they "didn't have the sense to buy the right kind of policy"?

[mykidslovedogs]

Martha,

You are right....I can't predict the future, but there are a lot of plans out there that are portable to a large majority of the States without the requirement of re-underwriting. This is something that the average person should think about when purchasing a policy. Some states will not be included, such as NY, because the carriers have chosen not to do business in a state that is unprofitable due to State mandates like community rating and guaranteed issue.

These carriers that have great portability from one state to the next include Assurant Health, UHC- Golden Rule, Humana, and Celtic Insurance. I am sure that there are more in other states that I am not aware of.

What causes reputable individual insurance carriers like Mutual of Omaha to drop out of the market are usually poorly thought out Federal and/or State regulations that cause immediate and irreversible damage to company profitabililty (such as guaranteed issue and community rating mandates) I obviously have no control over these kinds of legislation. Most reputable insurance carriers do not drop out of the market just to purposely hurt hundreds of people.

However, just because we can't predict the future does not mean that we have to force everyone to have the same coverage. IMO that does more harm than good in the LONGRUN!

[Martha]

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Originally Posted by mykidslovedogs True, Medigap (supplemental private insurance) does work fairly well, but you sacrifice selection in that process. There are only something like 6 different Medigap plans, and the only plans that are worth anything are Plans F and J. Our culture demands freedom of choice. Would you like it if your choices for private insurance were limited to two or three Federally mandated plan designs? I'll bet most people would answer NO to that question. A lot of people still don't buy Medigap because they feel like it is too expensive, and the lower cost options aren't worth the price.

You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression.

I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

[mykidslovedogs]

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Originally Posted by FIRE'd@51 This is exactly my point. And you have no way of knowing for sure that all the people to whom you are recommending Assurant (or any other carrier) won't end up exiting the individual insurance market for exactly the same reason. Will you then say they "didn't have the sense to buy the right kind of policy"?

So we screw up health care for everyone, just because a tiny percent of people will be adversly affected by irresponsible legislation (community rating and guaranteed issue) that they, themselves, have voted for? Assurant Health has been in business for over 50 years in the individual market. The likliehood of them dropping out is slim to none, and it probably will only happen if more and more states continue to move to community rating and guaranteed issue. The legislation that people with pre-existing conditions vote FOR is what leads to their own demise.

[bright eyed]

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Originally Posted by Martha You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression. I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

well said!

[FIRE'd@51]

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Originally Posted by mykidslovedogs So we screw up health care for everyone, just because a tiny percent of people will be adversly affected by irresponsible legislation (community rating and guaranteed issue) that they, themselves, have voted for? Assurant Health has been in business for over 50 years in the individual market. The likliehood of them dropping out is slim to none, and it probably will only happen if more and more states continue to move to community rating and guaranteed issue. The legislation that people with pre-existing conditions vote FOR is what leads to their own demise.

Many of the people with current pre-existing conditions didn't have them when they first took out their insurance. They didn't vote for anything. They just were unlucky. They carried insurance for many years and then lost it due to a quirk in the system.

My wife has a policy with Assurant. She was originally with Mutual Of Omaha. When MOH exited the individual market, Fortis (now Assurant) looked over the risk pool she was in and cherry-picked the healthy people. They offered her a policy (not-guaranteed issue) at an attractive premium. Now I see exactly the same thing going on with Assurant that happened with MOH prior to them leaving the market. The 15-20% premium increases every 9 months. I don't know how you can be sure they won't exit the individual market. Oh BTW, I also had a $5000 deductible policy with MOH - had it for 10 years - never collected a dime (and I'm thankful for that). However, I was declared uninsurable and ended up with a guaranteed-issue policy from BCBS, at nearly double what I was paying MOH for approximately the same coverage. Thanks to HIPAA no waiting periods. But htese things just shouldn't happen, One buys insurance for a sense of security.

[mykidslovedogs]

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Originally Posted by Martha You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression. I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

Martha,
I agree with you that many people in the USA have sacrificed happiness AND HEALTH for greed, MONEY AND HIGH STRESS JOBS. I'll bet 80% of my applicants take anti-depressants, and at least half are overweight or obese, but those are lifestyle CHOICES. There are a lot of things our culture could do to facilitate better choices, but instead, we have let our moral values deteriorate to the point where are children are taught (particularly by the entertainment industry) to value money and possessions over happiness.

All of that has nothing to do with my point here. Universalizing healthcare is a BAD idea. When you take away choice (in the healthcare industry), you can't possibly ADD quality in the choices. IMO, Most people will be alienated or forced into something that they didn't really want (especially when we reap the unintended longterm consequence - lack of true access to care - because certain kinds of care will not be readily available AT ALL). A few will have something better than they had before. "Quality" is subjective and dependent upon perception. For me, quality (from a healthcare perspective) is a 5000 deductible health insurance plan combined with 100% coverage for any major medical care I might need in the future as well as accessibility to any kind of care I will need. Actually, accessibility is more important to me than the risk of a high deductible, which I can take a loan out to pay for if I have to. For you, "quality" is something different (perhaps a low deductible plan for all with plenty of "front end" benefits such as copays and a drug card, and you seem to be willing to sacrifice of quality of care as a means to the end - coverage for all). IMO, we should all be "Free" to choose what we want. I believe in freedom of choice. I also have a lot of confidence that the marketplace will eventually resolve the problems for the great majority of people.

Why do you assume that your definition of quality, when it comes to healthcare should be imposed upon me or anyone else?

People in America want the best possible care. Most Americans percieve "quality" as being able to have a mammogram on the latest equipment when we want to and not having to wait on THE LIST for several weeks for surgery while worrying about dying while we wait. Take a look at what socializing the system did to Canada....people there are NOT happy with the system, and they are BEGGING legislators to legalize private health insurance. I posted a couple of links earlier in the thread. I simply prefer choice over lack of access to care. With that may come the sacrifice of a small percentage of people having less access than other people. To me, it makes more sense that only a few people are disadvantaged, than having EVERYONE be disadvantaged in the name of equality.

[Rich_by_the_Bay]

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Originally Posted by brewer12345 I agree thata the current system makes no sense. However, for those of us who may have to contemplate buying our own insurance at some point, having regulatory schemes taht have different rules in different places is of some use. If I am in good health when I RE, I can move where I please, especially to a low cost state with cheap insurance (maybe CO, for example). If I have some sort of health issue, I can stay in a guaranteed issue state (may not be cheap, but at least it will be available).

True enough, but many of us (esp with families) reach points where your choice of home towns is driven by other factors: care of elderly parents, desire to be near kids, personal interests and friends, or even the need for assisted living and so on. At that stage, one doesn't necessarily have the luxury of making a savvy choice from an insurance perspective. Life intervenes.

[Rich_by_the_Bay]

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Originally Posted by mykidslovedogs I guess if all doctors decided one day to stop contracting with insurance carriers, then you all wouldn't have to worry about which state you move to.

Actually, to reply to the absurd example, there are laws against doctors colluding in such a manner as I understand it. But more importantly, the main reason is that carriers have a virtual stranglehold on many markets. The competing carriers dominate the system (and are employer-based), ratchet down prices and each demands the use of their own "preferred" labs, imaging centers, and other services; these can change often with upheaval in the paperwork and so on. Failure to "participate" by doctors is possible in selected circumstances but ruinous to new practitioners who have no established practice. They kite payments by delaying on technicalities and the paperwork requires added personnel in the office who do nothing but fight denied claims, many of which are hung up on trivial issues. It's a nightmare.

There are examples of doctors fighting particularly foul carriers (Aetna comes to mind years back), but as a sustained, organized global boycott it is no longer realistic. The market is too heavily under the chokehold of the carriers.

It would be like an autobody dent shop not accepting anything related to car insurance.

[mykidslovedogs]

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Originally Posted by FIRE'd@51 Many of the people with current pre-existing conditions didn't have them when they first took out their insurance. They didn't vote for anything. They just were unlucky. They carried insurance for many years and then lost it due to a quirk in the system. My wife has a policy with Assurant. She was originally with Mutual Of Omaha. When MOH exited the individual market, Fortis (now Assurant) looked over the risk pool she was in and cherry-picked the healthy people. They offered her a policy (not-guaranteed issue) at an attractive premium. Now I see exactly the same thing going on with Assurant that happened with MOH prior to them leaving the market. The 15-20% premium increases every 9 months. I don't know how you can be sure they won't exit the individual market. Oh BTW, I also had a $5000 deductible policy with MOH - had it for 10 years - never collected a dime (and I'm thankful for that). However, I was declared uninsurable and ended up with a guaranteed-issue policy from BCBS, at nearly double what I was paying MOH for approximately the same coverage. Thanks to HIPAA no waiting periods. But htese things just shouldn't happen, One buys insurance for a sense of security.

That is very unfortunate. What state do you live in? MOH left the market, IMO, because they were forced to by irresponsible legislators, Left of Center, who felt like they were doing "good" by forcing community rating and guaranteed issue on a couple of States where MOH had a great majority of their business. This legislation made it almost impossible for MOH to remain profitable in the individual business, thus they were driven out of the market .

The people who voted for this irresponsible leglislation left a lot of people alienated in the name of equality for the sake of a minority of uninsurable people who didn't buy health insurance, like you did, when they were healthy enough to qualify for it. Now, you are on the "other side", and your misfortune is blindsighting you, because legislation that you would be in favor of, legislation that would seem "fair" to you, will alienate another large quantity of people, by taking away choice and quality of care.

I realize that you think your rates are high now, but just imagine how much you (or people younger than you) will pay out in a universalized system. Were talking a minimum of a 40% increase in income taxes almost immediately. That will do for a while, until demand begins to exceed supply at an excessive rate..at which point, we will have to start paying premiums on top of taxes for our care, and last, but not least, 10-20 yrs down the road, we might as well forget being able to have an MRI or CT scan when we need one or surgery when we need or want it. Instead, we will be on a long waiting list.

[Rich_by_the_Bay]

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Originally Posted by FIRE'd@51 In a previous post (look back) you said the portability was just between selective states and certain carriers, not universal. I also think your last sentence shows complete insensitivity to the person who did think ahead and buy the right policy, then lost it through a quirk (e.g. his carrier left the individual insurance market and canceled his policy).

And that is commonplace. "Uninsurable" in a realistic sense means that you simply can't by insurance even on your own, from the carriers realistically available to you at that point in time. This is not a "very, very small percentage" in my experience, but actually rather common. That is why COBRA exists, among other reasons.

[bright eyed]

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Originally Posted by mykidslovedogs Take a look at what socializing the system did to Canada....people there are NOT happy with the system, and they are BEGGING legislators to legalize private health insurance. I posted a couple of links earlier in the thread. I simply prefer choice over lack of access to care. With that may come the sacrifice of a small percentage of people having less access than other people. To me, it makes more sense that only a few people are disadvantaged, than having EVERYONE be disadvantaged in the name of equality.

Um, i don't think most proposals you will see in the next decade will include the options people considered in the clinton era or universal canada type system. Americans are both uninformed and too wary of those two. Most politicians are now talking about using the private system to cover the uninsured.

It's just plain dumb to have a group of uninsured people - we all end up paying for it in the end. Some estimate americans pay 40% more than other ind'd countries

Aside from being a bit heartless, your assumption about the vast leap of sacrifice you imagine you would have to make seems disproportionate to the actual outcome of whatever plan may take hold. Most countries manage to take care of their populations without sacrificing so many and then paying more in the end...

I'd rather have less so everyone can have some (particularly preventative care) and I'd assume that rates wouldn't change vastly for everyone after the system readjusts from the current stupidity...

[mykidslovedogs]

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Originally Posted by Rich_in_Tampa Actually, to reply to the absurd example, there are laws against doctors colluding in such a manner as I understand it. But more importantly, the main reason is that carriers have a virtual stranglehold on many markets. The competing carriers dominate the system (and are employer-based), ratchet down prices and each demands the use of their own "preferred" labs, imaging centers, and other services; these can change often with upheaval in the paperwork and so on. Failure to "participate" by doctors is possible in selected circumstances but ruinous to new practitioners who have no established practice. They kite payments by delaying on technicalities and the paperwork requires added personnel in the office who do nothing but fight denied claims, many of which are hung up on trivial issues. It's a nightmare. There are examples of doctors fighting particularly foul carriers (Aetna comes to mind years back), but as a sustained, organized global boycott it is no longer realistic. The market is too heavily under the chokehold of the carriers. It would be like an autobody dent shop not accepting anything related to car insurance.

I realize the example was absurd. The point was, there are "capitalistic" reasons for doctors to contract with insurance carriers...Namely to build up a business when first starting out and also to guarantee payment. You see, without insurance companies, I believe doctors would struggle with collections even worse than they do now. (this is because most people think they are entitled to services without paying for them).

A single payor system might make it easier on existing doctors as far as collections, but it might be harder to build up a new practice, unless you are a very saavy business man/woman. And with the low pay you are guaranteed to get from the government, the cost of marketing a new practice might even be prohibitive, without having access to the insurance carrier's huge referral networks.

[mykidslovedogs]

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Originally Posted by bright eyed Um, i don't think most proposals you will see in the next decade will include the options people considered in the clinton era or universal canada type system. Americans are both uninformed and too wary of those two. Most politicians are now talking about using the private system to cover the uninsured. It's just plain dumb to have a group of uninsured people - we all end up paying for it in the end. Some estimate americans pay 40% more than other ind'd countries Aside from being a bit heartless, your assumption about the vast leap of sacrifice you imagine you would have to make seems disproportionate to the actual outcome of whatever plan may take hold. Most countries manage to take care of their populations without sacrificing so many and then paying more in the end... I'd rather have less so everyone can have some (particularly preventative care) and I'd assume that rates wouldn't change vastly for everyone after the system readjusts from the current stupidity...

Well, the main reason we have such a problem with preventive care in the USA today is BECAUSE there is too much demand as compared to supply created by the Federally funded Medicare and Medicaid systems. Doctors don't get paid enough by the gov't to become primary care physicians so they opt for specialist careers where they can make more money. How do you think it will be better in a universalized system?

I don't think it will be possible to utilize private insurance to insure everyone. That means mandates placed on private enterprise, which drives competition out of the marketplace. Even if we could make it work, there won't be very many choices. Most insurance companies will just drop out of the healthcare business, leaving just a couple to take care of everyone. Government mandates and private enterprise do not go well together.

If you are going to universalize care, it has to be from the gov't. The next question is, do we make it the same for everyone by disallowing private insurance altogether, or do we allow people to purchase supplemental plans? If we do allow supplemental coverage, that still means there will be inequality, which the Left does not tolerate very well. If we make private insurance illegal, then there will be people waiting on waiting lists for services eventually.

BTW - Did you know that Mass is thinking about canning their "new" system as they are now discovering that it is going to cost 2-3 times more than what they budgeted?

[Rich_by_the_Bay]

I think the "solutions" being advocate here are patronizing and insulting; in this bizarre argument, you should a) lock in to a private individual policy unrelated to your employment at age 22, b) forego or double-pay employer-sponsored health insurance by continuing to pay your personal insurance for 40 years even if you are part of a group policy, c) avoid getting sick so you don't get dropped or underwritten, and d) do all this through an insurance agent whose incentives are ambiguously aligned.

And be sure you don't move to the wrong state somewhere along the line. Oh - and be sure that you don't become uninsurable by the next time your plan may be dropped or re-built as a different product by your carrier - so don't get lymphoma or lupus or renal failure or have a stroke or melanoma.

This ain't politics (incessant quips notwithstanding) - we are talking about peoples' lives, and they are not all dumb losers who brought it on themselves.

[mykidslovedogs]

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Originally Posted by Rich_in_Tampa I think the "solutions" being advocate here are patronizing and insulting; in this bizarre argument, you should a) lock in to a private individual policy unrelated to your employment at age 22, b) forego or double-pay employer-sponsored health insurance by continuing to pay your personal insurance for 40 years even if you are part of a group policy, c) avoid getting sick so you don't get dropped or underwritten, and d) do all this through an insurance agent whose incentives are ambiguously aligned. And be sure you don't move to the wrong state somewhere along the line. Oh - and be sure that you don't become uninsurable by the next time your plan may be dropped or re-built as a different product by your carrier - so don't get lymphoma or lupus or renal failure or have a stroke or melanoma. This ain't politics (incessant quips notwithstanding) - we are talking about peoples' lives, and they are not all dumb losers who brought it on themselves.

Rich,

Don't worry. Once we go universal, we won't get employer sponsored benefits anymore. We'll simply pay out the ying yang in income taxes (probably more than what a private policy would have cost)....and you won't get "benefits" anymore, because they won't be necessary, so you won't have to worry about "double-paying" or "foregoing" benefits. You'll just pay twice as much in taxes for half as good of coverage than you would have paid for your own, personal policy.

BTW - Insurance carriers can't just drop you personally because you get sick or personally price you out of the market because of your personal claims. Like Mutual of Omaha, they can drop a whole line of coverage if they are forced out of business by irresponsibile legislation that bankrupts them, but they can't just drop someone because they get sick. And they can only raise your rates by the same percentage that they raise everyone else's rates...you can't be singled out for a rate increase. IMO if moving makes getting healthcare prohibitive for you, then don't move. For the large majority of people, moving will not be a problem.


And Rich, don't you think that being in your line of business, you would naturally think that more people are sick and "uninsurable" than what there really are? I mean, your job is to take care of sick people. I am willing to bet that the statistics are not as high as you think they are. I'll have to do more research. I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

[2B]

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Originally Posted by mykidslovedogs I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

Come to Texas and find out. We probably have the worst state insurance plan in the nation.

A major factor in my retirement will be getting affordable health insurance. It's too bad I lived until I was 50 and have half the problems most people my age have. I'll still be forced into the "high risk pool" where I'll pay $7K per year and have a $5K deductible per person.

Unless we find a way to keep people that have paid for insurance for most of their lives insured at a reasonable cost, we will have a continuing joke of what passes for health insurance.

[Martha]

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Originally Posted by mykidslovedogs And Rich, don't you think that being in your line of business, you would naturally think that more people are sick and "uninsurable" than what there really are? I mean, your job is to take care of sick people. I am willing to bet that the statistics are not as high as you think they are. I'll have to do more research. I'll bet the population of chronically ill people who don't currently have any coverage is a lot lower than you think it is.

This is a tough number to get your arms around. I have seen estimates as low as 2 to 5% of the population as having chronic conditions. This was, IIRC, from proposals from the current administration concerning HSAs. Other estimates are as high as 50% of the population. I suppose it depends on how you define chronic. For example, does it include high blood pressure? Roughly one in five people have high BP. One in 10 have depression

I have read that the percentage of people with chronic conditions that are unisured is actually lower than the percentage of uninsured in the general population. Part of the reason for this may be that the elderly are more likely to have chronic conditions and medicare is available to them. But even among the non-elderly, those with chronic conditions are more likely to be insured. This survey (somewhat dated and limited to certain chronic conditions only) reports 88% of the non-elderly chronically ill have insurance vs. 81% of the general population: http://www.markle.org/resources/facc...ntFile_287.pdf

However, even if the chronically ill have insurance they cannot always afford the cost of medical care. For example, you might not be able to afford the drugs necessary to treat the chronic condition. Non-compliance with treatment programs is a big problem for the chronically ill and is in part likely due to cost. This is a big problem for many who have to take a number of medications to treat their illnesses. Medicare, until recently, didn't cover drugs. Drug co-pays can be high. Research regarding HSA and high deductibles show a reduction in compliance with drug treatment.

I have also read that the chronically ill are more likely to stay with a job they are having difficulting in doing or otherwise want to leave because of "job-lock", staying at a job just to keep the health insurance.

Anyway, it is a big and complicated question, not just turning on whether someone is insured or not.

[mykidslovedogs]

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Originally Posted by 2B Come to Texas and find out. We probably have the worst state insurance plan in the nation. A major factor in my retirement will be getting affordable health insurance. It's too bad I lived until I was 50 and have half the problems most people my age have. I'll still be forced into the "high risk pool" where I'll pay $7K per year and have a $5K deductible per person. Unless we find a way to keep people that have paid for insurance for most of their lives insured at a reasonable cost, we will have a continuing joke of what passes for health insurance.

The biggest part of this problem here is that people HAVE NOT paid for their own insurance most of their lives....their employers paid for it FOR THEM, and now they are spoiled, so when they retire, they think that they should have insurance for a fraction of what it really costs because they have never had to pay for it on their own, and they really don't have a clue about the true cost!

Health insurance is expensive because health CARE is expensive. Maybe the gov't could try placing cost controls on our providers?....I mean, not just via Medicare and Medicaid, but perhaps the gov't should prohibit providers from shifting lost profits (due to low Medicaid and Medicare reimbursement) to the private sector as well.....That's what's going to happen eventually anyway (in a universalized system...There won't be a private sector to shift costs to). So why go through all of the trouble of becoming universalized? Let's just pass legislation prohibiting providers from cost-shifting! That will fix everything, right?

Try living in Canada....they don't even cover prescriptions on their universal plan. The goverment simply can't afford to subidize prescriptions anymore. Is that the kind of healthplan you want? At least with a high deductible plan, you have a cap on your out of pocket costs, including prescriptions. In Canada, you get to pay 40% higher taxes there than in the USA PLUS about $125.00 in monthly premiums and you still have to pay for all of your own prescriptions out of pocket.