Interesting Re: Canadian Health Care

[kcowan]

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.

 

[kcowan]

...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.

 

[bright eyed]

thx for the 411 kcowan...

 

[Meadbh]

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.

 

[chinaco]

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.

 

[Billy]

Kcowan:

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.

Be well,

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[kumquat]

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.

 

[kcowan]

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.

Be well,

Akaisha
Author, The Adventurer's Guide to Early Retirement

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.

 

[Meadbh]

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.

 

[Billy]

Kcowan

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.

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.

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.

Best of health,
Akaisha
Author, The Adventurer’s Guide to Early Retirement

 

[kcowan]

...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...

 

[Billy]

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.

Be well,
Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[kcowan]

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:

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.

 

[Billy]

Kcowan

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.

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…

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!

Akaisha
Author, The Adventurer’s Guide to Early Retirement

 

[lets-retire]

Billy good post. So how would you suggest fixing the health care system?

 

[kcowan]

I experience the market forces with my dental and pharmacy services where I pay and then collect from my private insurance company. It does make a difference. My dental coverage only supports teeth cleaning every 9 months so that is the cycle I am on even though they recommend every 6 months for me. They started giving me a fluoride rinse which is not covered so I got them to stop. I use a fluoride mouthwash instead. The copay is growing every year so that now it is over 50%.

On pharmaceuticals, it is also a copay (80%) so I shop around for the best deal and order in large quantities to spread the dispensing fee.

I see this as the best way to control costs. If the insurer limits my choices, then I am not getting the best care. Let them set their payment schedules and then I can decide how much of it I want to pay for my own choice. This can apply to both Canada and the US.

However, the combination of the powerful insurance lobby and the politicians is a major barrier to improvment. Some companies have moved to a health savings account. This enables those with good health and habits to get 100% coverage and carry forward any balance to cover major surgery.

 

[Infidel]

Question: why does she not get a dirt-cheap high-deductible catastrophic plan? Better yet, get a plan like that that's HSA qualified? I had one such plan recently, that, as a single, 43yo, non-smoking male ran me about $120/mo with a $2M cap. I'm with her in saving money if you're healthy, but I want some kind of safety net if something big and very bad happens.

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.

 

[Billy]

Lets-retire

Billy good post. So how would you suggest fixing the health care system?

Thanks, LR...

I have a fantasy plan that could be a start. I'm sure there are lots of folks that could punch holes into it, but it stresses free market forces, and is based on the premise that the US is going to have some sort of Universal Care in the future.

I am not presumptuous to think that I know all the answers or that this 'Plan" offers all the answers. And, of course, there would be a rather rocky integration time period when everyone would be screaming - patients, doctors, hospitals, and most of all, insurance companies.

For fun, here goes:

The Plan

The US government/tax payers would deposit into every US citizen’s personal account $5,000 per year for their health care needs adjusted to inflation. This money is for doctor and hospital visits, not your local drugstore, unless prescribed by the doctor. This plan would also encourage citizenship because the illegals would be ineligible for the plan. A great side benefit.

This money would be in a special liquid account unable to be used for other purposes. After the end of a 10 year period,-- for those over 30,-- and not until they reach 30 for younger folks-- the first year’s amount is available to them for any purposes they desire (like for houses or education, a boat or vacation). Another benefit of this program will be the infusion of money back into the system keeping our economy rolling.

People will be given a debit card, and when patients go to their doctor/hospital, this card will be swiped, and the amount will be taken from the balance. Your balance will be available to you online, 24/7 the same as your credit card information. Doctors would be paid immediately for their services instead of having to fill out reams of forms and wait for payment from health insurance companies, thus streamlining the system.

Because of this immediate payment, more doctors, clinics and hospitals would be attracted to this system.

This plan is going to instill competition into the market place. Now, when you go to the doctor, as a customer, you will shop for the best doctor at the price you are willing to pay. Prices will drop due to this competitive market place, just like prices have dropped in Lasik eye surgery because these procedures are not covered by insurance today.

Doctors will soon be posting a menu of their services and prices just as any other business. They will also take out ads in newspapers and on radio advertising specials as they do for Lasik in the States and as they do for all procedures in Thailand. From dental work to breast implants with prices listed, ads are in the Thai English papers daily.

Patients wouldn’t have to worry about pre-existing conditions, or being refused for coverage, because the insurance companies would no longer be in the picture. (eventually, insurance companies would phase out... - my hope!)

So what happens if you go into the hospital and you have incurred a $100,000 bill?

First of all the amount wouldn’t be that high because the prices would have dropped.

Secondly, you will have at least $50,000 in your account (plus interest) if you have had a 10 year holding period.

Also, the doctors and hospitals have a form for an additional 30% off if you promise not to sue if there’s a problem. Why pay for their liability coverage if you’re willing to go ahead without it?

This is the way to solve the health care problem and bring about world peace.

** $5,000 is an arbitrary number and if it isn’t enough, then make it $10,000.
The Plan is subject to change, but it’s a start.

Be well,
Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[lets-retire]

Question: why does she not get a dirt-cheap high-deductible catastrophic plan? Better yet, get a plan like that that's HSA qualified? I had one such plan recently, that, as a single, 43yo, non-smoking male ran me about $120/mo with a $2M cap. I'm with her in saving money if you're healthy, but I want some kind of safety net if something big and very bad happens.

Sometimes she's not the brightest bulb in the pack. Once she gets something stuck in her mind it is almost impossible to get it out. She still insists on carrying full coverage on her car that is over ten years old. Her reasoning is if she is involved in a crash she will have some money coming back from her insurance to pay for another one. I tried to explain that if she dropped her full coverage she would be able to take her savings, put it in some type of investment and within a year have more than the insurance company will giver her.

 

[Rustic23]

Billy,
If my calculator is correct, at $5,000 per person per year that is 1.5 Trillion dollars a year. As I said if that is the right figure, how are you going to pay for it? ($5,000X300,000,000)

 

[Billy]

Rustic23

Billy,
If my calculator is correct, at $5,000 per person per year that is 1.5 Trillion dollars a year. As I said if that is the right figure, how are you going to pay for it? ($5,000X300,000,000)

Thanks for reading our (fantasy) plan and for waiting for a response, Rustic23. We are currently in the Philippines, and finding internet cafes is still a challenge, since we have not been here before.

First of all, I don’t believe this plan would have a snowball’s chance to be implemented - because it would require personal responsibility.

As it is, we don’t know how Medicare and Social Security for all the Boomers are going to be paid for yet it is being promised… And the idea of Universal Care is being tossed around like it is ‘the answer’ - OMG how is that going to be covered? By us, the taxpayers, right? Yet payment isn’t being questioned - the ‘government’ will cover it.

The $5,000 per person idea was so that the money eventually would be re-entered back into the system through market forces. Right now, with the guaranteed payment system that we have, the system itself is sucking up the money without hope of control.

Hillary offered $5,000 for every newborn child just the other month on some program she was trial ballooning out there, and I don’t know how she intended to pay for it except through raising taxes.

The guaranteed payment system that we have now keeps growing out of control without any hope of containment that the free market would provide.

I realize there are two camps on this line of thought. Those who want the government to provide health care so that we citizens ‘don’t have to worry about it at all’ and those who believe that personal responsibility and market forces will act as a pricing control mechanism just as any other free market.

‘Course we could always cut spending and reallocate funds… What a novel idea!

What I don't understand, is that we as a country are generally self reliant - we are self reliant when it comes to purchasing our own homes, cars, food, travel expenses, etc. but for some reason when it comes to health care we need 'help.'

Why does self-reliance go out of the window when it comes to health care? We have been told now for decades that health care is a constitutional right and that the government 'should' provide it. What about food, clothing and shelter? these are important too, but we don't have food insurance, or cothing insurance or anthing of this nature.

There was a recent Rassmussen poll that was taken where 1/2 of Americans support the notion of providing health care free to all Americans even though "they expect it will reduce the overall quality of care, increase the ovrall cost and increase their personal costs." ...

This line of thought confuses me...

Thanks again, Rustic23

Be well,
Akaisha
Author, The Adventurer’s Guide to Early Retirement

 

[Grizz]

What about food, clothing and shelter? these are important too, but we don't have food insurance, or cothing insurance or anthing of this nature.

Welfare

There was a recent Rassmussen poll that was taken where 1/2 of Americans support the notion of providing health care free to all Americans even though "they expect it will reduce the overall quality of care, increase the ovrall cost and increase their personal costs." ...

I'm one of those Canadians with "free" health care. I also get taxed at a combined provincial and federal tax rate of 39%. BTW our health care system is still short of funds, and long wait lines are the norm. Don't look north for your solution.

 

[lets-retire]

What about food, clothing and shelter? these are important too, but we don't have food insurance, or cothing insurance or anthing of this nature.

Welfare

Welfare is only for the poor with children, similar to Medicaid. I think both those programs are good, they just need better mechanisms to enforce existing regulations and regulations implemented to lower the amount of abuse.

Having a universal health care program seems a little foolish, when you consider if a person can't eat or drink, all of the health care in the world will not do much good. Many health problems are directly related to how much and what a person eats. If the government can control what a person puts in their mouth then the population will be much healthier and the government can save a lot of money in terms of health care. I can go much further into the argument for national food provision, but in my view it is more satire than serious debate.

 

[kumquat]

I also get taxed at a combined provincial and federal tax rate of 39%.

Top marginal rates in Canada exceed that. Until lowered a few years ago, my top marginal; rate was 52% and is now around 48% (I think).

 

[Grizz]

Top marginal rates in Canada exceed that. Until lowered a few years ago, my top marginal; rate was 52% and is now around 48% (I think).

I'm taxed at the highest combined rate for my province (Alberta). To be honest I thought that you were full of it when you said that you paid 48%, but I checked the tables and most provinces really are around that level. A real jaw dropper. Any place but Alberta also has a provincial sales tax. I'm definitely not saying that Alberta is the greatest place on earth, but how do you save any money at all, and for someone who is trying to RE, why stay there?