# health care



## itsb (Jan 13, 2013)

we all know that o-boma care is a huge disaster, but what about our neighbors to the north in Canada,dont they some sort of health care and if so how does it work and how do you rate it


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## BlackFeather (Jun 17, 2014)

Not sure but England's health care has long waits, poor service and if your old and sick, they let you die. My plan would be to do away with insurance companies. When you buy cell phone service you pay your provider, why in health care do we pay a middle man? I could see a plan where hospitals have memberships, you pay your member fees to them directly, The hospital pays your doctor, since most doctors need to have hospital privileges anyway, let them be a sub contractor with the hospital. Once you pay your membership you have so many visits free each year, and a co-pay if you exceed the predetermined amount. (to discourage hypochondriacs) The free market worked out the problems with cell service, roaming fees and such, let the free market work out the problems with hospitals, and transfers to specialty hospitals. Since all doctors would be under contract with a hospital, let the hospital pay any mal-practice insurance. In areas with more than one hospital let them compete for patients. Eventually the accountants will see that a hospital will make more money by keeping their clients healthy than treating them after they are sick and there will be more preventative programs for sickness. Lastly reform the ability to have law suits, so many are without foundation. 

Let the free market deal with costs, not using a socialist way. Socialism always costs more and gives worse care. There is a story of a doctor who was going to set up something like I described above, and New York came in said "your not an insurance company" and stopped him. He figured his entire client base would only have to pay about $95 a year per person and he could avoid all insurance companies and offer care when ever his patients needed it. New York wanted to protect the insurance companies so they stopped him. The patients were receptive of his idea.


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## Nevada (Sep 9, 2004)

BlackFeather said:


> My plan would be to do away with insurance companies.


I think the days when we could get along without medical insurance are long gone. Medical problems are not like dental problems, which can often be paid for out of pocket. Medical problems can be catastrophic, such as an unexpected heart attack sometimes costing $400,000. Where is a typical American family going to find $400K without insurance?


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## no really (Aug 7, 2013)

Good question, have you checked the gofundme medical pages, as in many. Apparently it's not working all that good. Reason I found it is a friend's son has a serious medical problem, her insurance is not covering much they are already in the red for around 100,000. She has pretty good insurance through her job.

After hearing about the Canadian system, I think we should give it a serious look.


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## itsb (Jan 13, 2013)

ya the canadanin is what I was woundering about


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## painterswife (Jun 7, 2004)

The Canadian system works much better. They provide heath care for everyone for almost half of what it costs here and not everyone is covered.

There are differences.

You need to buy your own insurance for prescriptions that are not administered in a hospital.

There are no deductibles.


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## MO_cows (Aug 14, 2010)

I have heard a lot more good than bad about the Canadian system. Thing is, though, they have what, 10 provinces, while we have 50 states??? Plus we have a much larger population to care for, our system would be several times over the size of theirs. And I'm also wondering what percentage of their population is "non productive" compared to ours. We couldn't just adopt their system if we wanted to, but maybe the principles could be applied. 

But there simply has to be a better mousetrap than what we have now! I have a Bronze insurance plan that I pay for out of my own pocket. With age 60 right around the bend and smoking, I pay well over $500 a month for it. Due to procrastination, our doctor moving out of town, loss of the good insurance we used to have and so forth, I got way behind on my screenings and checkups. In the last month, I have had an exam at the GP's office, pelvic exam/PAP smear, mammagram, bone density scan, blood work, and a colonoscopy. I have filled out at least 100 pages of forms, had my photo taken at multiple places, copy of my drivers license put on file at several places, and the GP's office wants to put my debit card on file and just help themselves to my money! It is a clown rodeo all the way around. And even with the insurance, my out of pocket was over $500 so I have paid over $1k this month just to find out the current state of my health. (Which is pretty good, if anybody cares!)

There has got to be a better way.


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## wr (Aug 10, 2003)

It's easier to answer specific questions than to offer a response to a general question about our health care. 

My family is no different than most and have had some big medical issues as well as the usual minor ones and I have no complaints but it is quite a bit different than what you may expect in the sense that access to surgeries, specialized treatment and certain tests is based on a priority system. 

We are entitled to basic care so if you need a cast, you get a plaster cast unless you pay for upgrades. If you need surgery or treatment quickly, you get it quickly but elective surgeries tend to have quite a bit longer wait times. 

Our system does not usually cover drugs unless administered in a hospital but there are provisions if they are cost prohibitive. 

The biggest drawback I see is misuse of ER's because people perceive our health care access as 'free' but that's being better managed by triage nurses assessing patient needs but it also brings on complaints by people who have been left to wait until actual emergencies are seen before a doctor has time to check out a kid that just needed a teaspoon of Buckley's.


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## Farmerga (May 6, 2010)

Nevada said:


> I think the days when we could get along without medical insurance are long gone. Medical problems are not like dental problems, which can often be paid for out of pocket. Medical problems can be catastrophic, such as an unexpected heart attack sometimes costing $400,000. Where is a typical American family going to find $400K without insurance?


 Or, it could be that government interference and the rise of the insurance industry have caused prices to skyrocket.


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## MO_cows (Aug 14, 2010)

Farmerga said:


> Or, it could be that government interference and the rise of the insurance industry have caused prices to skyrocket.


Those have both contributed to rising costs, but are not solely responsible. Advances in health care itself have made it more expensive. MRI, scopes, all kinds of diagnostic and screening tools that we didn't used to have. Today we do hip and knee replacements, where 30 years ago it would have just been a prescription for painkillers, etc.


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## no really (Aug 7, 2013)

MO_cows said:


> Those have both contributed to rising costs, but are not solely responsible. Advances in health care itself have made it more expensive. MRI, scopes, all kinds of diagnostic and screening tools that we didn't used to have. Today we do hip and knee replacements, where 30 years ago it would have just been a prescription for painkillers, etc.


I kinda wonder at times about that analogy. My brother just had Lasix surgery, state of the art facility. 10 years ago not only would his type of correction been very difficult it would have been much, much more expensive. Insurance doesn't that I know of cover this type of procedure. It could be other factors involved in that type of thing though, just a thought


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## Nevada (Sep 9, 2004)

Farmerga said:


> Or, it could be that government interference and the rise of the insurance industry have caused prices to skyrocket.


Most of the cost comes from new and expensive medical procedures. But we want those procedures, since they often save the lives of our loved ones.

I remember the day, back in the 50s & 60s, when there wasn't a lot they could do for heart disease. No stent, no bypass, no artificial valves. When someone had a heart attack all they could do was start oxygen and load them up on morphine. They either live or died. If they survived, the doctor told them how long they had to live. We would never accept that today, but it's expensive.

Cancer was a death sentence back then -- no exceptions. Diabetics were difficult to manage so they seldom survived past 50. There was no paramedic service, and ERs were staffed by doctors who were "on call" (they weren't there).

With few exceptions, we're willing to pay the price because lives hang in the balance. But who's going to pay for it all? We have to find cheaper ways to do it. We probably will also need to enact guidelines for when it's cost effective to do procedures at various ages (what republicans call rationing). Do we want to pay $500K to do a valve replacement or heart transplant for someone in their mid 80's who isn't likely to survive more than a couple of years? These are difficult discussions we'll need to have sooner or later.


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## wr (Aug 10, 2003)

painterswife said:


> The Canadian system works much better. They provide heath care for everyone for almost half of what it costs here and not everyone is covered.
> 
> There are differences.
> 
> ...


Like anything, it works well most of the time and you'll always hear complaints but it's worked well for my family. 

My youngest's made a dumb decision not to mention he'd inhaled a fencing staple and ultimately forgot about it for close to 10 years so what should have been a simple fix became a massive problem, embedded in a grapefruit sized mass of scar tissue almost completely blocking the airway of one lung. 

Finding a specialist able to tackle the problem was a a problem but from the day it showed up on an x-ray to the date of the fourth and final surgery was exactly 3 months and the day he walked out of the hospital, he owed nothing other than $25 for television rental.


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## Nevada (Sep 9, 2004)

no really said:


> Good question, have you checked the gofundme medical pages, as in many. Apparently it's not working all that good.


I wouldn't expect it to. Crowdfunding works on the same general principle as insurance, where funds from people who are not sick help pay medical bills for those who are. The big difference between crowdfunding and insurance is that crowdfunding is voluntary.

The problem with a voluntary system is that not enough funds get collected. It's not unusual for a family to spend $1,000/month for quality health insurance. But a $1,000/month voluntary contribution would be an exceptionally large donation. Because of it's voluntary nature, we could never expect crowdfunding to accomplish what insurance accomplishes.


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## no really (Aug 7, 2013)

Nevada said:


> I wouldn't expect it to. Crowdfunding works on the same general principle as insurance, where funds from people who are not sick help pay medical bills for those who are. The big difference between crowdfunding and insurance is that crowdfunding is voluntary.
> 
> The problem with a voluntary system is that not enough funds get collected. It's not unusual for a family to spend $1,000/month for quality health insurance. But a $1,000/month voluntary contribution would be an exceptionally large donation. Because of it's voluntary nature, we could never expect crowdfunding to accomplish what insurance accomplishes.


I was talking about gofundme, not the same. These are donations, the person posts in a very large website there medical costs with a bit of info and personal info.


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## keenataz (Feb 17, 2009)

wr said:


> Like anything, it works well most of the time and you'll always hear complaints but it's worked well for my family.
> 
> My youngest's made a dumb decision not to mention he'd inhaled a fencing staple and ultimately forgot about it for close to 10 years so what should have been a simple fix became a massive problem, embedded in a grapefruit sized mass of scar tissue almost completely blocking the airway of one lung.
> 
> Finding a specialist able to tackle the problem was a a problem but from the day it showed up on an x-ray to the date of the fourth and final surgery was exactly 3 months and the day he walked out of the hospital, he owed nothing other than $25 for television rental.


Generally that has been my experience. When it comes to acute care it is great, chronic care some issues and elective-not the best.

I had a couple of strokes 2 years ago. Ended up in hospital 8 days. Had every test you can imagine for a stroke including 2 mri's. Left with no payment. Now I know I do pay with my taxes, but I think I recouped my tax payments in that one trip.

I also what any system is going to look like in 20 years when the majority of baby boomers have moved on (likely). Are we going to have empty hospitals like we do schools now?


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## no really (Aug 7, 2013)

Forgot the website

https://www.gofundme.com/Medical-Illness-Healing/


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## Nevada (Sep 9, 2004)

no really said:


> I was talking about gofundme, not the same. These are donations, the person posts in a very large website there medical costs with a bit of info and personal info.


Sure. That whats known as crowdfunding. In this case it's donation-based crowdfunding for a charitable cause.


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## no really (Aug 7, 2013)

Nevada said:


> Sure. That whats known as crowdfunding. In this case it's donation-based crowdfunding for a charitable cause.


Which still begs the question why do they need it with our insurance system? How is that my friend is looking at 100,000 in bills with her insurance, which is considered pretty good?


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## no really (Aug 7, 2013)

wr said:


> Like anything, it works well most of the time and you'll always hear complaints but it's worked well for my family.
> 
> My youngest's made a dumb decision not to mention he'd inhaled a fencing staple and ultimately forgot about it for close to 10 years so what should have been a simple fix became a massive problem, embedded in a grapefruit sized mass of scar tissue almost completely blocking the airway of one lung.
> 
> Finding a specialist able to tackle the problem was a a problem but from the day it showed up on an x-ray to the date of the fourth and final surgery was exactly 3 months and the day he walked out of the hospital, he owed nothing other than $25 for television rental.


Glad to hear he made a great recovery. Incredible to get that kind of treatment without being bankrupt. Thanks for giving first person experience.


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## Nevada (Sep 9, 2004)

keenataz said:


> Generally that has been my experience. When it comes to acute care it is great, chronic care some issues and elective-not the best.


To be fair, we're also having problems with chronic care in the USA. That's because more and more people in the USA are using HMO insurance.

With an HMO you assign the management of a lot of your health care to the insurance company, so they are making a lot of health care decisions for you. You can save a lot of money with an HMO if you're healthy, but since HMOs make their money by denying care you don't want it with bad health. So if you're on an HMO and you develop health problems you would want to change away from an HMO as soon as possible. Their decisions about your health care are, of course, based on what it costs rather than what might be in your best interest.

If an HMO decides that you aren't going to get a procedure there's not a lot you can do about it. You have the right to appeal, but the insurance company's doctors will be the judges. Good luck on that.


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## Nevada (Sep 9, 2004)

no really said:


> Which still begs the question why do they need it with our insurance system? How is that my friend is looking at 100,000 in bills with her insurance, which is considered pretty good?


I'm not sure. I suppose every case is unique.

I had a friend who had a $400K heart attack. Insurance covered most of the medical costs, but he couldn't work for a long time. People in the community put up a gofundme page and held a local benefit event to raise money to help support his family until he could get back to work.

[ame]https://www.youtube.com/watch?v=fnj43ufi-Io[/ame]


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## no really (Aug 7, 2013)

Well my friends bill is for her child, not being out of work. And it is an ongoing illness, auto immune, so the bills will continue.


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## watcher (Sep 4, 2006)

Nevada said:


> I think the days when we could get along without medical insurance are long gone. Medical problems are not like dental problems, which can often be paid for out of pocket. Medical problems can be catastrophic, such as an unexpected heart attack sometimes costing $400,000. Where is a typical American family going to find $400K without insurance?


True but the leaches want someone else to pay for their basic health care and/or to cover them after they are already sick. It'd be like wanting insurance to cover preventive maintenance on your car and/or to have it repaired after you have wrecked it.

For decades I had catastrophic insurance it only covered huge medical expenses such as you bring up. But I paid for office calls when I got sick (pink eye, sinus infection, etc) and paid for the meds when I needed them. It wasn't until we had kids until I started buying insurance to cover more. It was a simple economic decision, kids tend to need medical care than healthy adults so it made sense.


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## watcher (Sep 4, 2006)

The major problem I see with the Canadian system are the wait times. The wife had an accident and broke three ribs. Four weeks later when the pain from the ribs lessened she noticed her shoulder was hurting. She went in and they did an MRI right there in the office. The odds she will be operated on within a week. 

According to the official Ontario wait time site (http://www.ontariowaittimes.com/Surgerydi/en/PublicMain.aspx) the *AVERAGE* wait time for shoulder surgery is 188 days. That would be 188 days of pain and near sleepless nights.


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## Nevada (Sep 9, 2004)

watcher said:


> True but the leaches want someone else to pay for their basic health care and/or to cover them after they are already sick. It'd be like wanting insurance to cover preventive maintenance on your car and/or to have it repaired after you have wrecked it.
> 
> For decades I had catastrophic insurance it only covered huge medical expenses such as you bring up. But I paid for office calls when I got sick (pink eye, sinus infection, etc) and paid for the meds when I needed them. It wasn't until we had kids until I started buying insurance to cover more. It was a simple economic decision, kids tend to need medical care than healthy adults so it made sense.


As I pointed out earlier, there is a price to pay for managed healthcare. When you signup with an HMO you let the insurance company make a lot of your healthcare decisions for you. It's a good deal if you're healthy, since office visits and other routine care is available for small copays, but not so great if you develop health problems.

HMOs are generally good for younger people and kids, since they are healthy for the most part.


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## City Bound (Jan 24, 2009)

Nevada said:


> I think the days when we could get along without medical insurance are long gone. Medical problems are not like dental problems, which can often be paid for out of pocket. Medical problems can be catastrophic, such as an unexpected heart attack sometimes costing $400,000. Where is a typical American family going to find $400K without insurance?


does it seriously cost that much? Why so Much?

I knew a doctor who worked in an ER and she made 100 dollars an hour and worked 90 hour shifts a week. That is 36 grand a month. That is close to half a million a year. Her sister was a doctor who was married to a doctor and who worked at a very good hospital and together they made over a million dollars a year as a couple.

Isn't that nuts? They make more in an hour then some people make all day. They make more in a month then many people make in a year. 
This was 15 years ago so I would think they get more an hour now.

Do they really have to charge so much?
If I did not know that our government would run the system into the ground by incompetence and plundering I would support social medicine.

The way everyday low income citizens are treated in this country is inhumane. I understand peoples anger but I am leery of socialism or communism because they can be even more inhumane.

The NHS over in the UK is good and it is bad. I know some people that use it. Recently they had a crises with ambulance service. They could not afford to properly run their ambulance service and people were being neglected and some died because of it.


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## Farmerga (May 6, 2010)

MO_cows said:


> Those have both contributed to rising costs, but are not solely responsible. Advances in health care itself have made it more expensive. MRI, scopes, all kinds of diagnostic and screening tools that we didn't used to have. Today we do hip and knee replacements, where 30 years ago it would have just been a prescription for painkillers, etc.


 As technology advances, price tends to fall. Look at Lasik for a medical example. Look at your cell phone (if you have one) for another and the computer for another.


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## City Bound (Jan 24, 2009)

watcher said:


> The major problem I see with the Canadian system are the wait times. The wife had an accident and broke three ribs. Four weeks later when the pain from the ribs lessened she noticed her shoulder was hurting. She went in and they did an MRI right there in the office. The odds she will be operated on within a week.
> 
> According to the official Ontario wait time site (http://www.ontariowaittimes.com/Surgerydi/en/PublicMain.aspx) the *AVERAGE* wait time for shoulder surgery is 188 days. That would be 188 days of pain and near sleepless nights.


 
In the UK 15% of your paycheck automatically goes to pay for NHS. They also have private hospitals and doctors that you can go to. Wealthier people in the UK use both. They go private and the doc will take whatever the nhs will pay and then the person's private insurance pays the rest or whatever portion that is covered. That might work if you are wealthy but poorer people are stuck with whatever the nhs covers. Now will all the immigrants coming over tot the uk just to get on welfare the system is being crippled


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## mmoetc (Oct 9, 2012)

You claim to be leery of socialism and communism yet you criticize doctor's pay as being excessive. What are 8-12 years of education worth? What is your life worth when you show up at the emergency room? I don't have a problem with doctors getting paid. I do have a problem with what we pay them for. Walking into a hospital room and signing a chart adds no value to a patient's care yet it is paid at the same rate as a physician who ordered the care. Diagnosing a patient and ordering tests should be paid. Getting paid because the doctor owns the lab or diagnostic center the tests are done at because of the doctor's "suggestion" should be looked at. There's a lot of waste in our system. Doctor's pay might be least of them.


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## City Bound (Jan 24, 2009)

people using the ER as a doctors office is not solely because poorer people going there for colds are playing a trick. Some are, but many go there because many GP's don't take Medicaid and most clincs that do take Medicaid have a wait of up to month or more. People go to the clinic with a cold or a stomach virus and the clinic tells them the doctor can see them in a month, then the patient says, "I cant wait I am sick now," then clerk says, "If it is an emergency then you need to go to the emergency room." That is one of the main reasons you see them there. Gp's do not want to take them because Medicaid pays about 25% of the bill and receiving payment from them is such a hassle that many doctors can not be bothered. Why spend thousands of dollars having your book keeper chase down hundreds of dollars from Medicaid, it makes no sense.


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## Truckinguy (Mar 8, 2008)

Our system does have it's issues but overall I think it's pretty good. My Dad had two heart surgeries 11 years apart and no bills, my Mom had eight kids, had great care from the hospital and no bills. Wait times are a concern but if you have an problem that needs immediate treatment the care you get is top notch. If I can be debt free by the time I retire I will only need a few hundred dollars a month to live a quiet retirement life and not have to worry about how I'm going to pay for health care. I can also be free to choose whichever job I want without having health insurance be a deciding factor. I've heard some Americans say they work at a job they hate just because it has great health insurance.


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## mmoetc (Oct 9, 2012)

City Bound said:


> people using the ER as a doctors office is not solely because poorer people going there for colds are playing a trick. Some are, but many go there because many GP's don't take Medicaid and most clincs that do take Medicaid have a wait of up to month or more. People go to the clinic with a cold or a stomach virus and the clinic tells them the doctor can see them in a month, then the patient says, "I cant wait I am sick now," then clerk says, "If it is an emergency then you need to go to the emergency room." That is one of the main reasons you see them there. Gp's do not want to take them because Medicaid pays about 25% of the bill and receiving payment from them is such a hassle that many doctors can not be bothered. Why spend thousands of dollars having your book keeper chase down hundreds of dollars from Medicaid, it makes no sense.


Thanks for a rather unneccessary and simplistic explanation of something I didn't ask about. I'll ask it simply- what should an ER doctor make?


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## mmoetc (Oct 9, 2012)

Truckinguy said:


> Our system does have it's issues but overall I think it's pretty good. My Dad had two heart surgeries 11 years apart and no bills, my Mom had eight kids, had great care from the hospital and no bills. Wait times are a concern but if you have an problem that needs immediate treatment the care you get is top notch. If I can be debt free by the time I retire I will only need a few hundred dollars a month to live a quiet retirement life and not have to worry about how I'm going to pay for health care. I can also be free to choose whichever job I want without having health insurance be a deciding factor. I've heard some Americans say they work at a job they hate just because it has great health insurance.


The thing about wait times is you get what you pay for. You can set up a system where you get in line and be patient with non emergency issues an keep costs down and focus on things that do require immediate care. Or you can treat everything as an emergency. The costs of those systems is easily compared as are the outcomes. We in the US pay vastly more for immediate care and the outcomes don't differ.


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## FarmerKat (Jul 3, 2014)

I cannot speak for Canadian or UK system, but I grew up in another European country with universal healthcare and it does have good and bad points. First of all, it is not free - if you have income, you pay 13.5% for health insurance. Here are some actual figures to put this in perspective:

Average monthly wage is $1,040
Minimum monthly wage is $396
Minimum monthly insurance premium is $53 ($72 for self-employed) 
The monthly insurance paid by state (unemployed, disabled, retired, welfare recipients, women on maternity leave, etc.) is $34

The good part is that most doctor visits or medications require only a small co-pay ($1-$5). My mom has a wonderful family doctor that comes to her once a month for her check up and it only costs her about $1 in co-pay. The bad part is that if you have something more serious, you have to wait. My sister-in-law waited 9 months for a finger surgery. 

The access to modern technology in hospitals is fairly good (I would feel completely comfortable getting treated there). But even though hospitals have been modernized, most still have rooms that are shared by 4-8 people. If you want a single or double room, you have to pay for it. My mom is physically disabled and the hospital she was in did not have a single bathroom (in the room or elsewhere) that she could use by herself (something she can do as long as there is a space for a wheel chair and grab bars). 

One big issue is quality of doctors. The state does not pay very much. A family doctor in the state system makes $1,600-$1,900/month. This means that most doctors put in the time they have to put in out of school and - if they are any good - open a private, cash only practice. Many also leave to work in other countries that pay more. What you are left with in the state system are either doctors who stay because that's where their heart is or those who cannot make it in the private sector (you can guess how many of each there are left). Same thing with nurses (average pay is $1,300/month). A large number of nurses leave to work in other countries.


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## City Bound (Jan 24, 2009)

mmoetc said:


> You claim to be leery of socialism and communism yet you criticize doctor's pay as being excessive. What are 8-12 years of education worth? What is your life worth when you show up at the emergency room? I don't have a problem with doctors getting paid. I do have a problem with what we pay them for. Walking into a hospital room and signing a chart adds no value to a patient's care yet it is paid at the same rate as a physician who ordered the care. Diagnosing a patient and ordering tests should be paid. Getting paid because the doctor owns the lab or diagnostic center the tests are done at because of the doctor's "suggestion" should be looked at. There's a lot of waste in our system. Doctor's pay might be least of them.


 
Yes, I think charging 100 to 200 an hour is not only excessive but it is exploitive. I do not think the gov should make laws to cap their salary but I do think that doctors and hospitals should check their conscience and recall that they are there to help people and to do no harm.

One trick the doctors do is they pop in for a few minutes to ask how you are. Well, that is not a friendly visit. They pop in for a five minutes and charge your insurance for an hour visit.
Sure, if they have to come in for a real reason pertaining to your health then that is legit but to pop ad work a little insurance scam like that is low.

My neighbor had a crazy bill from the hospital and one of the charges was for a doctor she did not even know. The doctor just stock his head in the door and said "I am an associate of your doc and he asked me to see how you are doing." Everyday all he did was pop his head in the door and say "hello mrs______ . How are you feeling today?" She would say good or so so and he would pop his head out the door and walk away. He never even entered the room and it cost her $400 every time this crook came around. 

I know they need to over see but come on be reasonable. Is five minutes of your time really worth $400. People are not rich and they cant afford this.

Time, time, time, I always hear this. What about al the people forced to go to school all their lives and they can not find a decent job? I guess they can show up at mc donalds and say I want $100 an hour because I spent 12 years in school learning. isn't that the entitlement mentality, but only for the middle and upper class? The say, I deserve this and I deserve more, just like many people on welfare say, I deserve this and I deserve more.
They think they earned an entitlement somehow. 

The example I gave of the doc I knew, she got her school all paid for. All she had to do was to promise to work in a city hospital for four years. She was still making near half a mil but she had to work in a bad area of town.


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## City Bound (Jan 24, 2009)

mmoetc said:


> Thanks for a rather unneccessary and simplistic explanation of something I didn't ask about. I'll ask it simply- what should an ER doctor make?


 That post was not a response to you.

In a free market you can charge whatever you want. The immoral and economically unbalanced element is when people who have no choice but to ask for services also have no power to effect the cost of those services. 
Many times it is basically pay or die of your health concern or emergency. 

Personally, I think it would be nice if a doctor worked an lived in a community and his or her prices reflected the buying power of that community. That would be balanced, but that would rarely happen.


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## painterswife (Jun 7, 2004)

I find having lived under both systems the biggest pro for the Canadian system is the lack of worry.

Not having to worry if you can pay the bills. Not having to worry if you will bankrupt your family. I will take the wait times for non serious medical problems over those every time.


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## wr (Aug 10, 2003)

watcher said:


> The major problem I see with the Canadian system are the wait times. The wife had an accident and broke three ribs. Four weeks later when the pain from the ribs lessened she noticed her shoulder was hurting. She went in and they did an MRI right there in the office. The odds she will be operated on within a week.
> 
> According to the official Ontario wait time site (http://www.ontariowaittimes.com/Surgerydi/en/PublicMain.aspx) the *AVERAGE* wait time for shoulder surgery is 188 days. That would be 188 days of pain and near sleepless nights.


We've discussed this quite often and I doubt if it will change your mind but those 'average wait times' you prefer to quote cover a wide range of issues, including elective surgeries. 

As we have always indicated, urgent situations take priority over non urgent and elective surgeries so statistics don't tell the whole story as your own article indicates that the woman will be having surgery quite promptly. 

My daughter needs surgery after she was struck by a hit and run driver and like others, it followed a certain protocol. Tests were performed to ensure the nature of her injury, she asked her doctors to try less invasive treatment, which showed little improvement and she'll be in surgery next week. 

She could have had it done right after the accident or very quickly at any point since but it was her choice to delay surgery until she was convinced there was no other option. 

When I messed up my ankle, I would have barely had time to make it into Calgary in time for my surgical date but I chose to decline for specific medical reasons. If I changed my mind now, my doctors would take into consideration the fact that I declined emergency surgery, the fact that I'm reasonably comfortable most days, although a ruptured Achilles Tendon takes ages to heal and I'd be on the longer list. 

The last appointment I had to make with a GP for the big guy's physical was so quick that he literally couldn't make it back to town on 2 hours notice so we opted for the next day.


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## mmoetc (Oct 9, 2012)

City Bound said:


> Yes, I think charging 100 to 200 an hour is not only excessive but it is exploitive. I do not think the gov should make laws to cap their salary but I do think that doctors and hospitals should check their conscience and recall that they are there to help people and to do no harm.
> 
> One trick the doctors do is they pop in for a few minutes to ask how you are. Well, that is not a friendly visit. They pop in for a five minutes and charge your insurance for an hour visit.
> Sure, if they have to come in for a real reason pertaining to your health then that is legit but to pop ad work a little insurance scam like that is low.
> ...


Thanks again for explaining in more detail one of the problems I pointed out and ignoring the question I asked. What should an ER doctor make? Your friend gave up multiple years of her life to get her education. She had to give up four more for that "free" education. While you see it as being free that also come with the cost of lost earnings. Had she graduated after four or even six years in the proper field she could have been making money equal to what she made as an ER doctor and not been forced to work in a bad neighborhood. She likely would have worked in a very nice one. You say she worked 90 hour weeks. Ever tried it? I haven't and wouldn't want to especially if others lives laid in the balance. I'll ask again, what's your life worth when you get wheeled into that ER? The market dictates pay. I'll guess your friend was a good doctor. In another field or another specialty she could have worked far fewer hours, in much better conditions and with far less stress for the same money. 

After high school no one is forced to go to school. Want to get paid, choose a high paying in demand profession. When the oil patch was running hot I didn't hear anyone complaining that starting, low skilled workers were making $30-$50 per hour driving up production costs and costing me more at the pump. Or that the fast food workers were starting at $14/hr.

It's not entitlement if you work for it, sacrifice for it, and earn it. It is a touch socialistic to hint that those who have worked and sacrifice should get paid less for the good of society.


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## Nevada (Sep 9, 2004)

City Bound said:


> people using the ER as a doctors office is not solely because poorer people going there for colds are playing a trick. Some are, but many go there because many GP's don't take Medicaid and most clincs that do take Medicaid have a wait of up to month or more. People go to the clinic with a cold or a stomach virus and the clinic tells them the doctor can see them in a month, then the patient says, "I cant wait I am sick now," then clerk says, "If it is an emergency then you need to go to the emergency room." That is one of the main reasons you see them there. Gp's do not want to take them because Medicaid pays about 25% of the bill and receiving payment from them is such a hassle that many doctors can not be bothered. Why spend thousands of dollars having your book keeper chase down hundreds of dollars from Medicaid, it makes no sense.


If people are still going to the ER for colds then it's not the fault of patients, it's the fault of the medical community. Either the medical community isn't providing alternative clinics, they aren't providing the right incentives, or they want people to take colds to the ER. Let's not overlook the fact that the hospital will bill $1,000 for treating a cold.

I know that we don't have that problem around Las Vegas. You can see a provider at a lot of the chain pharmacies (most Walgreens & CVS) and at various 'quick care' clinics around town. In fact University Medical Center ER has a quick care clinic on site, so people who show up with colds will be directed to the quick care clinic by a triage nurse.

The financial incentives are there too. With my insurance I can go to a quick care clinic for a $10 copay, which is a whole lot less than my ER copay.

I suppose there are ERs that make a lot of money billing Medicaid for colds. I don't know what to say about that, but if there are no alternatives to the ER in that community you can't really blame the patients.


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## Jokarva (Jan 17, 2010)

City Bound said:


> does it seriously cost that much? Why so Much?
> 
> I knew a doctor who worked in an ER and she makes 100 dollars an hour and worked 90 hour shifts a week. That is 36 grand a month. That is close to half a million a year. Her sister was a doctor who was married to a doctor and who worked at a very good hospital and together they made over a million dollars a year as a couple.



Probably based on location, but I don't think that salary is typical. A friend is an ER Dr here and I know she doesn't make anything even close to that. When her husband lost his job she had to moonlight in other local ERs just to pay the bills.

And Drs who stick their heads in to check on a patient have generally already looked at labs, read nurse's notes, checked medications, etc, so it's not always as simple as it looks. Very little in medicine is as simple as it appears to be.


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## bluemoonluck (Oct 28, 2008)

I have talked to a pretty significant number of Canadians about their healthcare system, and they all seem to agree that for the basics it's fantastic. But the Canadian government runs it like a business, they focus on keeping it self-funding (paid for via taxes of citizens) and they loath to pay for anything that they feel is unnecessary. If you've ever wrestled with your own insurance company to get something covered that they don't want to pay for, you know the struggle.

Wait times to see specialists can be prohibitively long. Friend of mine had an infant who had major digestive issues, she had to wait for their regular doctor to refer her to a pediatrician (pediatricians are specialists in Canada, most babies see a regular family doctor). The pediatrician was a 3-4 hour drive each way. The pediatrician ran a bunch of tests and when they couldn't get to the bottom of it they referred her to a GI specialist. They were told that it was a 9 month wait to be called for an appointment to be scheduled and the appointment would be months after that call (!). Their baby was in constant belly pain and had diarrhea so badly that it was scalding her skin and leaving blisters on her bottom and legs....but that wasn't considered serious enough to merit being fast-tracked, and they figured they'd have to tough it out for a year or more before they'd see the GI doc. Instead they drove across the border to the USA, saw a specialist and paid out of pocket, got the issue resolved (it was a severe bacterial infection in the child's colon that is notoriously hard to get rid of), and by the time the GI's office called to schedule their Canada-paid appointment the baby was fine. 

Many will drive across the border to the USA to get MRI's and CAT scans done at private USA centers and pay the $500-$800 that they are charged out of pocket, because back in Canada they would have had to wait months for their turn. When another friend completely blew out her knee, she was told she'd be waiting 4-5 months for an MRI (!). Not only was that unnecessarily painful, but the delay in treatment could have lifelong complications. She drove to Buffalo NY, got the MRI done days after her initial consult in Canada (where she was told about the wait for the Canada-paid MRI), and was able to bring those results back to her Canadian doctor and get herself fast-tracked into surgery due to the findings. 

For those who think the USA should move to a socialist system of care, I simply tell them to look at the VA and see how it's run, then tell me if you want your own personal healthcare run the same way.


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## Nevada (Sep 9, 2004)

bluemoonluck said:


> For those who think the USA should move to a socialist system of care, I simply tell them to look at the VA and see how it's run, then tell me if you want your own personal healthcare run the same way.


You can't really compare the VA to the Canadian healthcare system on a heads-up basis. You might compare it to the healthcare system in England, but not Canada. The Canadian system uses private providers for the most part, while the VA provides medical services.

I suspect that if we go to single payer that it will be a lot more like the Canadian system than the English system.


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## bluemoonluck (Oct 28, 2008)

Nevada said:


> You can't really compare the VA to the Canadian healthcare system on a heads-up basis. You might compare it to the healthcare system in England, but not Canada. The Canadian system uses private providers for the most part, while the VA provides medical services.
> 
> I suspect that if we go to single payer that it will be a lot more like the Canadian system than the English system.


I'm not comparing the specific system...rather pointing out that the USA government ruins everything it touches. Medicare fraud is rampant, people wait months to get into the VA for pneumonia, and the amount of money that is spent per person is clearly NOT all going where it should be going. Too many pockets get lined when our government steps in to "help".


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## Nevada (Sep 9, 2004)

bluemoonluck said:


> Medicare fraud is rampant


There's a lot of Medicare fraud, but it's a big system. Compared to the profit overhead of private insurance (overhead + profit is typically 20%) Medicare is a pretty lean machine. Medicare does it for closer to 3%.


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## City Bound (Jan 24, 2009)

mmoetc said:


> Thanks again for explaining in more detail one of the problems I pointed out and ignoring the question I asked. What should an ER doctor make? Your friend gave up multiple years of her life to get her education. She had to give up four more for that "free" education. While you see it as being free that also come with the cost of lost earnings. Had she graduated after four or even six years in the proper field she could have been making money equal to what she made as an ER doctor and not been forced to work in a bad neighborhood. She likely would have worked in a very nice one. You say she worked 90 hour weeks. Ever tried it? I haven't and wouldn't want to especially if others lives laid in the balance. I'll ask again, what's your life worth when you get wheeled into that ER? The market dictates pay. I'll guess your friend was a good doctor. In another field or another specialty she could have worked far fewer hours, in much better conditions and with far less stress for the same money.
> 
> After high school no one is forced to go to school. Want to get paid, choose a high paying in demand profession. When the oil patch was running hot I didn't hear anyone complaining that starting, low skilled workers were making $30-$50 per hour driving up production costs and costing me more at the pump. Or that the fast food workers were starting at $14/hr.
> 
> It's not entitlement if you work for it, sacrifice for it, and earn it. It is a touch socialistic to hint that those who have worked and sacrifice should get paid less for the good of society.


I said that doctors should consult their hearts and charge according to their conscience. Peoples moral and ethical measuring sticks differ. Greedy people will charge as much as they can regardless of the patients economic status. Well, that is fine and legal but it is not exactly moral or ethical when the patient is not in a position to negotiate a fare price. Fare price? Well, how fare is it when the industry is monopolized. 

Some doctors are more ethical and have a sliding scale. 

If you are looking for an exact number then I cant give you one and no one else can ether. But that does not mean that these people can conjure up whatever price they want and we are forced to pay simply because we have no other choice. That is exploitive and an abuse of power.

So the time they spend in medical school is worth more then the time the average citizen is forced to surrender to government enforced education? S
Time is time, and if it boils down to time then everyone's time is worth something.

As for my friend. She had her school paid for and came out with no bills and was paid standard pay that all residents get paid. If she did not take that deal then she would have come out of school with debt and would still be making the same money. Sounds like she got a good deal to me. In the end she made out, no debt to pay back and the same pay as someone with debt. 

As for working 90 hours, well they do not work all those hours. They are on call for 90 hours. They are not slaving away in the salt mines for 90 hours. They sleep in their offices at night but are on call if they are needed. Some people are even at home getting paid to be on call. They are on duty but not always doing their job. So they get paid over a 100 dollars to watch tv in the lounge or sleep in their office. 

I get your point, but how much is too much or too little? There has to be a fare price where docs make great money but they are not making a killing at other people's expense. In the end we are a community not commodities.


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## watcher (Sep 4, 2006)

wr said:


> We've discussed this quite often and I doubt if it will change your mind but those 'average wait times' you prefer to quote cover a wide range of issues, including elective surgeries.


This is the average wait time for shoulder surgeries only, you can check times for other things at the site. 




wr said:


> As we have always indicated, urgent situations take priority over non urgent and elective surgeries so statistics don't tell the whole story as your own article indicates that the woman will be having surgery quite promptly.


I'm willing to bet that my wife would be WAY down on the list for surgery if the surgery would even be authorized in her case. The tear isn't huge (2 cm), she's ahh. . . older, the damaged shoulder is her 'off side' one and she still do most things. 




wr said:


> My daughter needs surgery after she was struck by a hit and run driver and like others, it followed a certain protocol. Tests were performed to ensure the nature of her injury, she asked her doctors to try less invasive treatment, which showed little improvement and she'll be in surgery next week.
> 
> She could have had it done right after the accident or very quickly at any point since but it was her choice to delay surgery until she was convinced there was no other option.
> 
> ...


Ok now think. With the speed of your cases how long are others waiting for treatment to have the average times to be so long? If the average wait time is 100 days and you get treated in 1 day that means there is someone out there who had to wait 199 days for treatment. Works out good when you are the 1 day person but it would kinda suck to be the other guy wouldn't it? And remember these numbers are at a government website. If a US hospital or doctor's office posted that the average wait time for shoulder surgery was 188 days it would be out of business because no one would go there.

Good service.
Fast service.
Cheap service.

You can only have two of the three.


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## wr (Aug 10, 2003)

watcher said:


> Ok now think. With the speed of your cases how long are others waiting for treatment to have the average times to be so long? If the average wait time is 100 days and you get treated in 1 day that means there is someone out there who had to wait 199 days for treatment. Works out good when you are the 1 day person but it would kinda suck to be the other guy wouldn't it? And remember these numbers are at a government website. If a US hospital or doctor's office posted that the average wait time for shoulder surgery was 188 days it would be out of business because no one would go there.
> 
> Good service.
> Fast service.
> ...


The lengthy wait times relate to those like myself, who literally chose not to have surgery when it was recommended or need minor additional tuneup work, like the big guy. 

By refusing surgery, we are essentially telling our doctor that we don't feel it's all that bad or we aren't overly uncomfortable and my daughter is going to find the same thing if her fear of needles causes her to back out of surgery. 

I know people who have waited for hip replacement for ages and others who hit the top of the list quickly but a lot has to do with taking a proactive approach to one's own health. 

I actually laughed at my son when he called to tell me about the fencing staple lodged in his lung because he commented that he'd be in surgery in a matter of weeks. I figured that since it and the resulting scar tissue had been where it was for 10 years, he'd wait a fair while but other than finding someone who was capable of handing the procedure, it was incredibly quick considering his doctors wanted a specific period of time between procedures.


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## FarmerKat (Jul 3, 2014)

I wonder if the long wait times have to do more with availability of doctors specializing in that particular area than bureaucracy. When we moved to TN, DH had to wait nearly a year for an appointment with a specialist. He was seeing the same specialist in FL (there it took 6 months to get the initial appointment) and he was simply trying to transfer from one doctor to another. I went to an ER with an issue and they wanted me to follow with a specialist. I am a self pay patient and I still had to wait 3 months to see one. 

I think that there is a lot of fraud in the system in the US - private and government run. Why would the insurance company agree to pay $700 for 45 minutes of physical therapy while a cash paying patient will pay $140? Why should the provider not figure out their cost, profit margin and charge everyone the same?


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## Nevada (Sep 9, 2004)

City Bound said:


> I said that doctors should consult their hearts and charge according to their conscience. Peoples moral and ethical measuring sticks differ.





FarmerKat said:


> Why would the insurance company agree to pay $700 for 45 minutes of physical therapy while a cash paying patient will pay $140? Why should the provider not figure out their cost, profit margin and charge everyone the same?


US medical providers go more by what the going rate is for a service in their area. If the going rate for a hip replacement is $50K in his area, that's what he's going to charge. Why wouldn't he?

The reason medical providers get away with it is because we don't have a way to comparison shop for medical services. It's not customary for medical providers to post their fee schedule.


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## FarmerKat (Jul 3, 2014)

Nevada said:


> US medical providers go more by what the going rate is for a service in their area. If the going rate for a hip replacement is $50K in his area, that's what he's going to charge.
> 
> The reason medical providers get away with it is because we don't have a way to comparison ship for medical services. It's not customary for medical providers to post a fee schedule.


There are services like Medical Blue Book https://healthcarebluebook.com/ that give an idea what the usual rate is for the area and it helps to shop around (assuming it's a planned procedure). 

The specific numbers were from the same provider. The $700 was the contractual price under their contract with DH's insurance company, $140 was their cash price. They did tell me that they have a different contractual amount with different insurance companies.


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## Nevada (Sep 9, 2004)

FarmerKat said:


> They did tell me that they have a different contractual amount with different insurance companies.


Oh sure. I think a lot of consumers would be shocked at how little insurance companies pay for services. An insurance company might only pay $3,500 to settle a $30,000 hospital bill.


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## wr (Aug 10, 2003)

FarmerKat said:


> I wonder if the long wait times have to do more with availability of doctors specializing in that particular area than bureaucracy. When we moved to TN, DH had to wait nearly a year for an appointment with a specialist. He was seeing the same specialist in FL (there it took 6 months to get the initial appointment) and he was simply trying to transfer from one doctor to another. I went to an ER with an issue and they wanted me to follow with a specialist. I am a self pay patient and I still had to wait 3 months to see one.
> 
> I think that there is a lot of fraud in the system in the US - private and government run. Why would the insurance company agree to pay $700 for 45 minutes of physical therapy while a cash paying patient will pay $140? Why should the provider not figure out their cost, profit margin and charge everyone the same?


I agree that there should be some middle ground on fees but one of my cousins is a doctor in the US and he tells me that receiving payment from insurance companies takes ages. 

I would also wonder how much of those cash payments for small services is entered into the books or deposited in bank accounts.


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## Nevada (Sep 9, 2004)

wr said:


> one of my cousins is a doctor in the US and he tells me that receiving payment from insurance companies takes ages.


Doctors sometimes refer to it as the "HMO treadmill."


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## watcher (Sep 4, 2006)

wr said:


> The lengthy wait times relate to those like myself, who literally chose not to have surgery when it was recommended or need minor additional tuneup work, like the big guy.
> 
> By refusing surgery, we are essentially telling our doctor that we don't feel it's all that bad or we aren't overly uncomfortable and my daughter is going to find the same thing if her fear of needles causes her to back out of surgery.
> 
> ...


I don't think people who defer surgery are counted in wait times on the official website. The wait time only counts from the time the person seeks surgery until the surgery is actually done.


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## keenataz (Feb 17, 2009)

watcher said:


> This is the average wait time for shoulder surgeries only, you can check times for other things at the site.
> 
> 
> 
> ...



Well I find we have all three. Although "cheap" is relative I guess. I am guessing our taxes are higher in Canada and I suspect one reason is to fund our health care. For me it is a worthwhile "investment" but others may disagree.

Although I have never experienced it yet, it does appear some wait times for elective stuff can be long, but as with everything in life there is good sand bad.


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## Nevada (Sep 9, 2004)

keenataz said:


> Although "cheap" is relative I guess.


I suppose "cheap" is a relative term, but there's no disputing that nobody, and I mean NOBODY, pays more than we pay for healthcare in the US. Healthcare in this country is the most expensive in the world -- hands down.

We don't get much for what we pay either. By every measure (life expectancy, infant mortality rate, hospital acquired infections, you name it) we don't rank well at all compared to other developed nations. Not only that, but millions in the USA are still without healthcare insurance.

The healthcare system in the USA is nothing short of a national disgrace.


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## keenataz (Feb 17, 2009)

Nevada said:


> I suppose "cheap" is a relative term, but there's no disputing that nobody, and I mean NOBODY, pays more than we pay for healthcare in the US. Healthcare in this country is the most expensive in the world -- hands down.
> 
> We don't get much for what we pay either. By every measure (life expectancy, infant mortality rate, hospital acquired infections, you name it) we don't rank well at all compared to other developed nations. Not only that, but millions in the USA are still without healthcare insurance.
> 
> The healthcare system in the USA is nothing short of a national disgrace.


Not going to comment on the US system as that could get me in a world of hurt. I just wanted to make sure there isn't the perception out there that our health care is "free". Sure we con't pay when we go to the dr or leave a hospital, but still it is paid for.


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## Nevada (Sep 9, 2004)

keenataz said:


> Not going to comment on the US system as that could get me in a world of hurt. I just wanted to make sure there isn't the perception out there that our health care is "free". Sure we con't pay when we go to the dr or leave a hospital, but still it is paid for.


Oh sure. The bills have to be paid one way or another.


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## wr (Aug 10, 2003)

watcher said:


> I don't think people who defer surgery are counted in wait times on the official website. The wait time only counts from the time the person seeks surgery until the surgery is actually done.



That is correct but if I opted to have my ankle rebuilt after deferring surgery, I'm not going to be placed on the urgent list. If i were to fall apart in some way, I'd be on the urgent list. 

My mother turned down gallbladder surgery because she felt it conflicted vacation plans and she got moved down the waiting list.


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## City Bound (Jan 24, 2009)

keenataz said:


> Not going to comment on the US system as that could get me in a world of hurt. I just wanted to make sure there isn't the perception out there that our health care is "free". Sure we con't pay when we go to the dr or leave a hospital, but still it is paid for.


 No, like it was said they take it from you in taxes like they do in the uk. 
If you make a 100 thousand pounds a year in the Uk you pay 15 thousand pounds in NHS tax.


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## watcher (Sep 4, 2006)

Nevada said:


> US medical providers go more by what the going rate is for a service in their area. If the going rate for a hip replacement is $50K in his area, that's what he's going to charge. Why wouldn't he?
> 
> The reason medical providers get away with it is because we don't have a way to comparison shop for medical services. It's not customary for medical providers to post their fee schedule.


I disagree. They "get away with it" because what do you care how much something cost if you are not paying for it? 

You do have a way to comparison shop for medical services, its called the telephone. You call the office and ask them how much they charge for a service. I do it all the time even though I'm not paying the entire bill. I ask them how much a bill would be if I paid them in cash, check, debit card or credit card. If its lower than what the insurance company would pay I will pay myself then file my claim myself.


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## watcher (Sep 4, 2006)

Nevada said:


> Oh sure. I think a lot of consumers would be shocked at how little insurance companies pay for services. An insurance company might only pay $3,500 to settle a $30,000 hospital bill.


Most people would be shocked to realize that if they offer to pay cash at time of service how much they could save.


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## Nevada (Sep 9, 2004)

watcher said:


> I disagree. They "get away with it" because what do you care how much something cost if you are not paying for it?


Most people will be paying a deductible & 20% copay, so they care plenty.


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## watcher (Sep 4, 2006)

keenataz said:


> Well I find we have all three. Although "cheap" is relative I guess. I am guessing our taxes are higher in Canada and I suspect one reason is to fund our health care. For me it is a worthwhile "investment" but others may disagree.
> 
> Although I have never experienced it yet, it does appear some wait times for elective stuff can be long, but as with everything in life there is good sand bad.


Your last statement is in direct conflict with your first. 

The wife called the ortho specialist herself, made an appointment and was seen within a week. No referral or wait time. Then after they had decided she probably had a slight tear in her rotor cuff she had the option of having her MRI done and read on the same visit in the same office for a non-emergency shoulder problem. Could you do the same in Canada?


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## Nevada (Sep 9, 2004)

watcher said:


> The wife called the ortho specialist herself, made an appointment and was seen within a week.


I made an appointment to see my primary physician and won't be seen for four weeks.


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## watcher (Sep 4, 2006)

wr said:


> That is correct but if I opted to have my ankle rebuilt after deferring surgery, I'm not going to be placed on the urgent list. If i were to fall apart in some way, I'd be on the urgent list.
> 
> My mother turned down gallbladder surgery because she felt it conflicted vacation plans and she got moved down the waiting list.


So if you wanted to have your ankle fixed you would expect to have to get a referral then wait to see the ortho then wait for an MRI then wait for surgery probably several months total, correct?

If I had the same problem I could call the othro tomorrow, have him do the MRI in his office and most likely have the surgery done before you could have gotten your MRI done. From what I have found I'd be willing to say there's a good chance I'd be at least halfway through rehab before you even hit the OR.


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## watcher (Sep 4, 2006)

Nevada said:


> Most people will be paying a deductible & 20% copay, so they care plenty.


Not that I have seen. Most people go to the doc and blindly follow orders. I ask why each test is necessary and if there is a different, cheaper, drug I could take.


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## watcher (Sep 4, 2006)

Nevada said:


> I made an appointment to see my primary physician and won't be seen for four weeks.


Won't be or can't be? If I couldn't get an appointment to see my doc for four weeks I'd be finding another doctor.


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## Nevada (Sep 9, 2004)

watcher said:


> Won't be or can't be? If I couldn't get an appointment to see my doc for four weeks I'd be finding another doctor.


If I was sick and needed to be seen I would have already been to a quick care clinic. With so many alternatives it's no longer customary to make room for sick people to see their doctor early. This is evidently how medicine is going to be practiced now.


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## Nevada (Sep 9, 2004)

watcher said:


> Not that I have seen. Most people go to the doc and blindly follow orders. I ask why each test is necessary and if there is a different, cheaper, drug I could take.


You can turn down a test if you wish, but you're letting your insurance company off the hook. If a doctor recommends a test and you refuse, it's assumed that they would have caught any problem early if the test had been done. Without the test you assume financial responsibility for those problems.

Needless to say, if a test is negative it wasn't necessary. But if it was positive...


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## BlackFeather (Jun 17, 2014)

Nevada said:


> I think the days when we could get along without medical insurance are long gone. Medical problems are not like dental problems, which can often be paid for out of pocket. Medical problems can be catastrophic, such as an unexpected heart attack sometimes costing $400,000. Where is a typical American family going to find $400K without insurance?


Our local hospital takes 65 million a year to run, it serves 85 thousand people. Divide 65 million by 85 thousand and you get roughly 800 dollars per person per year. For a family of 4 that is $3200. When I got family insurance through work, I paid about $100 per week. That is $5200 per year (more now with obama-care) What could our hospital do with that kind of money being directly paid to it on a membership basis verses going through insurance companies? If someone needed costly care or needed to be sent to a special hospital they could afford to cover it. Very few in a community need $400,000 treatments. Let the free market work.


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## Nevada (Sep 9, 2004)

BlackFeather said:


> Our local hospital takes 65 million a year to run, it serves 85 thousand people. Divide 65 million by 85 thousand and you get roughly 800 dollars per person per year. For a family of 4 that is $3200. When I got family insurance through work, I paid about $100 per week. That is $5200 per year (more now with obama-care) What could our hospital do with that kind of money being directly paid to it on a membership basis verses going through insurance companies? If someone needed costly care or needed to be sent to a special hospital they could afford to cover it.


You're describing socialized medicine.

But nobody except the government could organize such a thing.


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## coolrunnin (Aug 28, 2010)

BlackFeather said:


> Our local hospital takes 65 million a year to run, it serves 85 thousand people. Divide 65 million by 85 thousand and you get roughly 800 dollars per person per year. For a family of 4 that is $3200. When I got family insurance through work, I paid about $100 per week. That is $5200 per year (more now with obama-care) What could our hospital do with that kind of money being directly paid to it on a membership basis verses going through insurance companies? If someone needed costly care or needed to be sent to a special hospital they could afford to cover it. Very few in a community need $400,000 treatments. Let the free market work.


What about the cancer care clinics, private practice doc's specialist offices, and the other various medical facilities that don't rely on a hospital?


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## wiscto (Nov 24, 2014)

I don't have a problem with a full private model like ours. What I do have a problem with is the notion that the medical industry is entitled to whatever level of profit they feel they deserve. There are healthcare systems pulling something like 26% margins. Big Pharma is big money as well. I mean if investors want to bail on a sure thing because we capped profits/prices in order to reduce the cost to the consumer, I'd be more than happy to take their share of a sure thing. 

I also have a problem with people who think a hospital or even a clinic isn't a monopoly. It is a lot of the time, especially in small town USA. And it does cost us all money when one company tries to move in on another's territory. They still pay their staff competitive wages, but they're scrapping over consumers and losing money. They pass that cost onto consumers in cities/regions where they still hold total monopolies. And no one really has to know about it, because the Insurance Companies are actually absorbing as much of that as they can, because they're the ones consumers call and scream at. The Insurance Companies raise their rates slowly over time to cope with it. 

And there are some things we can do with that. Personally, I think the only reason we haven't is because Big Pharma and Big Healthcare own our politicians. I remember when Obama had his meeting with Congress after the ACA was passed. A Republican said, "Well why can't we open up the states and force insurance companies to compete nationwide." Obama said, "Yea we can do that, as long as we create some minimum coverages so Americans aren't faced with a race to the bottom, we can definitely do that." Oh look, a window of opportunity, a ray of light! NOPE. See nobody actually wanted to make sensible compromises in a bad situation to help the rest of us out, they just wanted to fight....either for their ideology or their donors. The Republicans handed the floor to Paul Ryan, who promptly changed the subject.


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## Elffriend (Mar 2, 2003)

keenataz said:


> I am guessing our taxes are higher in Canada and I suspect one reason is to fund our health care.


We moved from NJ to ON several years ago. The first year here we did the math and found that what we paid in taxes + insurance premiums in NJ was more than we paid in taxes in ON.


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## FarmerKat (Jul 3, 2014)

wiscto said:


> I also have a problem with people who think a hospital or even a clinic isn't a monopoly. It is a lot of the time, especially in small town USA. And it does cost us all money when one company tries to move in on another's territory. They still pay their staff competitive wages, but they're scrapping over consumers and losing money. They pass that cost onto consumers in cities/regions where they still hold total monopolies. And no one really has to know about it, because the Insurance Companies are actually absorbing as much of that as they can, because they're the ones consumers call and scream at. The Insurance Companies raise their rates slowly over time to cope with it.


That is true even in larger areas, not just small towns. When we lived in FL, there are basically two large hospital groups in metro Orlando. Here, in tri-cities in TN, we have two hospital groups and they are merging (http://becomingbettertogether.org/).

When we moved to this region, I called every family doctor in town and we were turned down for two reasons: 1) they do not take new patients at all or 2) they do take patients that take certain medications and some of those medications were the ones DH takes. We eventually found a nice doctor but she is 45 minutes away and is part of a large group. That means longer appointment times and more expensive. So with the exception of the two annual visits DH has to do in order to refill his prescriptions, we go to a walk-in clinic. It costs less, doctors are nice and they have things like x-rays, pharmacy, etc. on site. But I really do not like not having a relationship with a family doctor who knows you. I guess those are the days of the past ...


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## FarmerKat (Jul 3, 2014)

Elffriend said:


> We moved from NJ to ON several years ago. The first year here we did the math and found that what we paid in taxes + insurance premiums in NJ was more than we paid in taxes in ON.


Just curious, what is the tax rate in Canada that pays for the health insurance? 

I mentioned earlier in this thread that where I came from, the insurance tax rate was 13.5%. I can only think of 1 year in the past 10 years when we spent more than 13.5% of our gross income on premiums, co-pays, etc. It was during a year when one of us was faced with a serious health issue. Last year we spent about 3-4%, the year before that about 11%. That made me think that the tax rate in Canada must be smaller than what is common in European countries.


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## mmoetc (Oct 9, 2012)

City Bound said:


> I said that doctors should consult their hearts and charge according to their conscience. Peoples moral and ethical measuring sticks differ. Greedy people will charge as much as they can regardless of the patients economic status. Well, that is fine and legal but it is not exactly moral or ethical when the patient is not in a position to negotiate a fare price. Fare price? Well, how fare is it when the industry is monopolized.
> 
> Some doctors are more ethical and have a sliding scale.
> 
> ...


You do realize that doctors spent those same 18 years in government mandated education before they chose to engage in another 10-12 years of education to become a doctor. So yes, that additional 10-12 years is worth something. It is an investment in their future and deserves to be paid whatever the market says they are worth. I want well compensated doctors. I want wages and benefits that attract the best and brightest to the one profession that might save my life. To me, my life is priceless. ( I'm not sure all feel that way about me). 

Part of the cost of your friends "free" education was her loss of freedom. She didn't get to choose where she worked for four years of her life. Yeah, that's worth something. And many people get paid while on call. But few of them will have to put down the remote and jump off the couch to save someone's life at a moments notice. That's worth something to me.

I know doctors who do much beyond what they get paid for. Last week I sent thank you notes to a few who went above and beyond two years ago during my granddaughter's illness. I thanked them for their kindness and extra effort (much of which was never billed). I didn't begrudge them one dime of what they did bill for without their knowledge, dedication and effort I would have had six weeks less with that dear child than I did. And there's no price that can be placed on those six weeks, though the hospital tried.


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## wr (Aug 10, 2003)

watcher said:


> So if you wanted to have your ankle fixed you would expect to have to get a referral then wait to see the ortho then wait for an MRI then wait for surgery probably several months total, correct?
> 
> If I had the same problem I could call the othro tomorrow, have him do the MRI in his office and most likely have the surgery done before you could have gotten your MRI done. From what I have found I'd be willing to say there's a good chance I'd be at least halfway through rehab before you even hit the OR.


That is not correct. Obviously because I have a significant injury, I have an ortho, just like any other Canadian that would need a specialist. I'm simply saying that if I treat my health or condition as a non urgent issue, I can expect my team of doctors to treat it the same way and I don't feel I should have preferred treatment since I've chosen to defer surgery for a great many months. 

If there were a significant change in my condition that caused me to need surgery, it would be available quickly. 

Our system is based on need vs want so if I wanted breast reduction/augmentation, I'll wait a long while but my young friend that needed breast reduction surgery because it affected her health or another who had reconstruction surgery after breast cancer would be way ahead of me on the list.


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## Nevada (Sep 9, 2004)

wr said:


> Our system is based on need vs want so if I wanted breast reduction/augmentation, I'll wait a long while but my young friend that needed breast reduction surgery because it affected her health or another who had reconstruction surgery after breast cancer would be way ahead of me on the list.


How do they handle cosmetic surgery in Canada? Does government insurance cover things like fanny tucks and chemical peels? It's one thing to get plastic surgery after an auto accident, but quite another to get it for vanity.


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## Elffriend (Mar 2, 2003)

FarmerKat said:


> Just curious, what is the tax rate in Canada that pays for the health insurance?


I may be misunderstanding what you are asking, and if so please clarify, but I'm pretty sure that the tax we pay that goes to cover health insurance is not separated out from the rest of the income tax we owe. I'm not completely sure on that because DH usually handles filling out the tax forms. Perhaps if I'm wrong someone else from Ontario can pop in and correct me.

Edited to add:
Looks like it IS a separate item on payroll deductions. My DH is self employed so it is different for us.:
http://www.fin.gov.on.ca/en/tax/healthpremium/

According to that the tax ranges from nothing if you make less than $20,000 to $900 if your income is over $200,600.


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## FarmerKat (Jul 3, 2014)

Elffriend said:


> I may be misunderstanding what you are asking, and if so please clarify, but I'm pretty sure that the tax we pay that goes to cover health insurance is not separated out from the rest of the income tax we owe. I'm not completely sure on that because DH usually handles filling out the tax forms. Perhaps if I'm wrong someone else from Ontario can pop in and correct me.
> 
> Edited to add:
> Looks like it IS a separate item on payroll deductions. My DH is self employed so it is different for us.:
> ...


Thank you for your answer. When I lived in the Czech Republic, it was always a separate line item on the paycheck and the % does not change with income level.


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## wr (Aug 10, 2003)

Nevada said:


> How do they handle cosmetic surgery in Canada? Does government insurance cover things like fanny tucks and chemical peals? It's one thing to get plastic surgery after an auto accident, but quite another to get it for vanity.


I've never had such a thing but my godmother is fond of getting things lifted and shifted. According to her, Canadian prices for lift & shifts are quite costly so prefers to go to US clinics because they are either cheaper or comparable but also provide a luxury hotel atmosphere for recovery.


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## Nevada (Sep 9, 2004)

wr said:


> I've never had such a thing but my godmother is fond of getting things lifted and shifted. According to her, Canadian prices for lift & shifts are quite costly so prefers to go to US clinics because they are either cheaper or comparable but also provide a luxury hotel atmosphere for recovery.


OK, thanks. Evidently cosmetic surgery isn't covered.


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## mnn2501 (Apr 2, 2008)

watcher said:


> The major problem I see with the Canadian system are the wait times. The wife had an accident and broke three ribs. Four weeks later when the pain from the ribs lessened she noticed her shoulder was hurting. She went in and they did an MRI right there in the office. The odds she will be operated on within a week.
> 
> According to the official Ontario wait time site (http://www.ontariowaittimes.com/Surgerydi/en/PublicMain.aspx) the *AVERAGE* wait time for shoulder surgery is 188 days. That would be 188 days of pain and near sleepless nights.


Wait time vary depending on the seriousness of the situation.

From reading these boards, I find the only people that don't like the Canadian System are non-Canadians.


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## watcher (Sep 4, 2006)

Nevada said:


> If I was sick and needed to be seen I would have already been to a quick care clinic. With so many alternatives it's no longer customary to make room for sick people to see their doctor early. This is evidently how medicine is going to be practiced now.


If I were sick I'd call my doc and they'd either work me in today or see me 1st thing in the morning. I have a relationship with my doc which makes it much easier all around. For example when I have a sinus infection I don't have to spend 10 minutes telling a new guy I don't want nor need the latest antibiotic because for me sulfa drugs have always worked and worked really well for treating them and sulfa drugs are dirt cheap.

Dealt with the 'see a different doc every visit' in the military system (which if you know how it works you could make appointments with a specific doc). I didn't like it then and I don't like now, yeah I've used the walk ins before.


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## watcher (Sep 4, 2006)

Nevada said:


> You can turn down a test if you wish, but you're letting your insurance company off the hook. If a doctor recommends a test and you refuse, it's assumed that they would have caught any problem early if the test had been done. Without the test you assume financial responsibility for those problems.
> 
> Needless to say, if a test is negative it wasn't necessary. But if it was positive...


If you fall down and lacerate your arm would you follow the ER's doc recommendation for an X-ray when you knew how you fell, how your arm hit and there was zero indication of a fracture? How about a CAT or MRI to rule out concussion?

Talk to some docs and you will find out they routinely order extra test as a defensive measure in malpractice suits.


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## Nevada (Sep 9, 2004)

watcher said:


> If I were sick I'd call my doc and they'd either work me in today or see me 1st thing in the morning. I have a relationship with my doc which makes it much easier all around. For example when I have a sinus infection I don't have to spend 10 minutes telling a new guy I don't want nor need the latest antibiotic because for me sulfa drugs have always worked and worked really well for treating them and sulfa drugs are dirt cheap.
> 
> Dealt with the 'see a different doc every visit' in the military system (which if you know how it works you could make appointments with a specific doc). I didn't like it then and I don't like now, yeah I've used the walk ins before.


I'm not talking about seeing a different doctor each visit. I'm talking about seeing one primary care doctor for ongoing medical issues, but visiting an urgent care clinic for things that can't wait.

I don't know anything about where you live or your medical system, but seeing a primary care physician in a day or two just isn't the reality in Las Vegas. They're typically booked weeks in advance, but we have affordable alternatives ($10 on my plan) for problems that can't wait.

I have to admit that this system took a little getting used to, but I'm finding it to be workable. There are also some advantages. Alma used to get dehydrated in the summer and the urgent care clinic would start an IV to hydrate her for a few hours. That was something they weren't setup to do at her primary doctor's office, and it was a lot faster and less expensive than going to the ER.

It's really not that bad of a system. When you consider that emergency medicine is now a specialty, it makes sense to see someone who specializes in emergency medicine for urgent medical issues.


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## Nevada (Sep 9, 2004)

watcher said:


> If you fall down and lacerate your arm would you follow the ER's doc recommendation for an X-ray when you knew how you fell, how your arm hit and there was zero indication of a fracture? How about a CAT or MRI to rule out concussion?
> 
> Talk to some docs and you will find out they routinely order extra test as a defensive measure in malpractice suits.


I'll admit that defensive medicine practices are common, but that doesn't matter when it comes to your responsibility. Once the doctor writes in the chart that he recommended an x-ray and you refused, you can bet the farm that the insurance company will use it against you if they can. You never know when there might be an issue with your bones that is unrelated to the injury.

My advice is: you don't want a doctor writing in your chart that you refused any tests. I know for a fact that insurance companies look for that when they review cases.


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## mnn2501 (Apr 2, 2008)

watcher said:


> If I were sick I'd call my doc and they'd either work me in today or see me 1st thing in the morning. I have a relationship with my doc which makes it much easier all around.


Its wonderful that your doctor works like that, not everyone is so lucky.

I just tried changing doctors because mine moved and its becoming very inconvenient to have to take time off of work for routine med checks, etc. One reason I originally chose this doctor was because he was very close to both my work and my home, then after 6 or 7 years of going to him he moved his practice.

I called up one that had good reviews and tried to get in to see him. His first opening was 6 weeks away, needless to say I did not take the appointment.

The local doc-in-a-box (ie CareNow, etc) is starting to look much better these days.


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## watcher (Sep 4, 2006)

wr said:


> I've never had such a thing but my godmother is fond of getting things lifted and shifted. According to her, Canadian prices for lift & shifts are quite costly so prefers to go to US clinics because they are either cheaper or comparable but also provide a luxury hotel atmosphere for recovery.


So you have a prime example of how the free market is better than a government controlled one.


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## wr (Aug 10, 2003)

watcher said:


> If I were sick I'd call my doc and they'd either work me in today or see me 1st thing in the morning. I have a relationship with my doc which makes it much easier all around. For example when I have a sinus infection I don't have to spend 10 minutes telling a new guy I don't want nor need the latest antibiotic because for me sulfa drugs have always worked and worked really well for treating them and sulfa drugs are dirt cheap.
> 
> 
> 
> Dealt with the 'see a different doc every visit' in the military system (which if you know how it works you could make appointments with a specific doc). I didn't like it then and I don't like now, yeah I've used the walk ins before.



I can see my doctor the same day too. I simply call first or show up and they'll alway fit me in.


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## Nevada (Sep 9, 2004)

wr said:


> I can see my doctor the same day too. I simply call first or show up and they'll alway fit me in.


Doctors used to do that around here, but now that we have so many affordable alternatives they've stopped doing it. Personally I prefer it. I was always uncomfortable calling the doctor's office and begging the office staff to fit me in.


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## watcher (Sep 4, 2006)

mnn2501 said:


> Wait time vary depending on the seriousness of the situation.
> 
> From reading these boards, I find the only people that don't like the Canadian System are non-Canadians.


The point still stands you can not get a surgery you think you need when you think you need it. When you get your surgery is decided by the government.

My wife needs rotor cuff surgery. Its not life threatening and it doesn't cause her that much loss of use (she can still do 80-90% of what she used to) which means she'd probably be way down on the government's priority list. But she's in constant pain and has trouble sleeping because of the injury so she wants the surgery done asap. Here she gets to make the call when she gets fixed, not the government.


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## Nevada (Sep 9, 2004)

watcher said:


> The point still stands you can not get a surgery you think you need when you think you need it.


My point still stands as well. You can't get the surgery you think you need in the USA if you can't afford it.


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## wr (Aug 10, 2003)

watcher said:


> So you have a prime example of how the free market is better than a government controlled one.



If I was looking for a lift and shift, I guess you're right but I'm not inclined to believe it's an essential service and I'd much rather see those surgeons using their skills for people who need it.


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## keenataz (Feb 17, 2009)

watcher said:


> The point still stands you can not get a surgery you think you need when you think you need it. When you get your surgery is decided by the government.
> 
> My wife needs rotor cuff surgery. Its not life threatening and it doesn't cause her that much loss of use (she can still do 80-90% of what she used to) which means she'd probably be way down on the government's priority list. But she's in constant pain and has trouble sleeping because of the injury so she wants the surgery done asap. Here she gets to make the call when she gets fixed, not the government.


You are wrong, it has nothing to do with government control. No Dr. contacts the government to see if they can do work. Although there maybe be exceptions for experimental work.

My experience has been that you see your family dr. and he will refer you to a specialist. Depending on the urgency that referral can take less than an hour to a couple of months


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## bluemoonluck (Oct 28, 2008)

Nevada said:


> My point still stands as well. You can't get the surgery you think you need in the USA if you can't afford it.


Sure you can!

I was uninsured when I had my son 4 years ago, got all my prenatal care at the local health department - for which I paid based on a sliding scale, with the option of a payment plan if that was needed. When what should have been a routine delivery very quickly became an emergency c-section, I easily set up a payment plan with the hospital, which is a non-profit hospital, and made affordable (think $50) monthly payments on a sliding scale.

My friend fell off her horse last week and tore her knee up. She has no insurance and falls below the poverty line income-wise. The ER saw her, did x-rays, and gave her Rx's for pain meds (which she filled at WalMart, with no insurance, for $15). She has to fill out some paperwork and then they'll adjust her bills from the ER on a sliding scale (again, non-profit hospital) and she's seeing an orthopedist, getting an MRI, and likely getting surgery at a different semi-local teaching hospital.... on a sliding scale based on her income with affordable payment plans available.

Last year a friend with no insurance on the West Coast had a dog bite her young daughter in the face. ER visit was paid for on a sliding scale with affordable monthly payments, and they were able to refer her to a plastic surgeon (due to the location of the bite and age of the child it was deemed non-elective) who also saw them on a sliding scale and took payments.

Two years ago a dear friend who lives in the Midwest (no insurance, low income) had such severe pain that her regular doctor sent her for a CAT scan, where they discovered a huge tumor and ovarian cancer. Within weeks she was undergoing surgery at the Mayo Clinic to get it removed. Sliding scale and payment plan, yet again, for the win.

ER's in the USA have to see you if you NEED care. If you legitimately NEED something more, and cannot afford it, there are plenty of options for you to pursue.


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## Nevada (Sep 9, 2004)

bluemoonluck said:


> Sure you can!
> 
> I was uninsured when I had my son 4 years ago, got all my prenatal care at the local health department - for which I paid based on a sliding scale, with the option of a payment plan if that was needed. When what should have been a routine delivery very quickly became an emergency c-section, I easily set up a payment plan with the hospital, which is a non-profit hospital, and made affordable (think $50) monthly payments on a sliding scale.
> 
> ...


That particular discussion was about elective surgery. Go to an ER and ask for a fanny tuck you can't afford. See what they tell you.


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## watcher (Sep 4, 2006)

Nevada said:


> My point still stands as well. You can't get the surgery you think you need in the USA if you can't afford it.


What's the difference if you don't get the surgery because you can't pay for it yourself or because you can't get someone else to pay for it for you? I'll tell you the difference in these cases. In the first you are out nothing, in the second you are out the money the government took from you and promised you medical care.


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## watcher (Sep 4, 2006)

wr said:


> If I was looking for a lift and shift, I guess you're right but I'm not inclined to believe it's an essential service and I'd much rather see those surgeons using their skills for people who need it.


You don't get it do you. The reason your family member comes to the US is because she can get better or cheaper service because those providing those services must compete with others. Now don't you think the same thing would apply to your essential services if those services weren't government controlled?


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## keenataz (Feb 17, 2009)

watcher said:


> What's the difference if you don't get the surgery because you can't pay for it yourself or because you can't get someone else to pay for it for you? I'll tell you the difference in these cases. In the first you are out nothing, in the second you are out the money the government took from you and promised you medical care.


I am not sure why you think you would be able to get the surgery in Canada. Unless it is elective cosmetic surgery it will be paid for. You may have to wait in some cases and others you won't.


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## watcher (Sep 4, 2006)

keenataz said:


> You are wrong, it has nothing to do with government control. No Dr. contacts the government to see if they can do work. Although there maybe be exceptions for experimental work.


Really? So if you went in with a minor ankle problem the doctor could take you right into the OR and not face any government sanctions because it would not have classified your problem as needing immediate surgery?




keenataz said:


> My experience has been that you see your family dr. and he will refer you to a specialist. Depending on the urgency that referral can take less than an hour to a couple of months


My experience has been if I want to see a specialist rather than a GP, I call the specialist and make the appointment. I usually get an appointment within the week. No matter how the government would define the urgency of the situation.

This also shows how we view things differently. To you the thought of having to wait "a couple of months" to see a doctor is normal. Unless this doc was a miracle worker and/or was the best in the world being told I'd have to wait that long to see a doctor would be completely unacceptable.


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## keenataz (Feb 17, 2009)

watcher said:


> Really? So if you went in with a minor ankle problem the doctor could take you right into the OR and not face any government sanctions because it would not have classified your problem as needing immediate surgery?
> 
> 
> 
> ...



Well if I had a minor ankle problem, I would be questioning why I would need surgery. However if during the examination a serious acute problem was found, yes he could get surgery done.

And for the specialist, yes it is different. We do need referrals and depending on urgency there can be a wait. An example is-Because of my age a need a "very unpleasant procedure" done-probably can guess. As there are no known issues, it is routine and I am getting it done at the end of April. Which is soon enough.

However if I was showing symptoms of bowel or rectal cancer, I would likely be in next week.


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## Irish Pixie (May 14, 2002)

keenataz said:


> Well if I had a minor ankle problem, I would be questioning why I would need surgery. However if during the examination a serious acute problem was found, yes he could get surgery done.
> 
> And for the specialist, yes it is different. We do need referrals and depending on urgency there can be a wait. An example is-Because of my age a need a "very unpleasant procedure" done-probably can guess. As there are no known issues, it is routine and I am getting it done at the end of April. Which is soon enough.
> 
> However if I was showing symptoms of bowel or rectal cancer, I would likely be in next week.


My husband has the "very unpleasant procedure" next week and it took 6 weeks. Gasp. There are wait times in the US too!


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## Fennick (Apr 16, 2013)

FarmerKat said:


> I wonder if the long wait times have to do more with availability of doctors specializing in that particular area than bureaucracy. .........


Yes. You nailed it.

Wait times in Canada are a result of Canada not having enough medical professionals, nor enough facilities nor medical equipment. Some communities are so isolated they have no health professionals or facilities and patients needing health care have to travel long distances to locations where the services they need are available. 

What Canada does have is modern and top of the line, there's just not enough of it for Canada's growing population. Add to that, Canada has suffered for a long time from brain drain (other countries tempting Canada's medical graduates away from Canada with promises of more money, more perks, more opportunities, better climate, more chances of fame and glory, etc.).

Somebody mentioned something about Canada's healthcare system being a for-profit business run by the federal government. Not so. It isn't federal and it isn't a for profit business. It's provincially run, not federally run but each of Canada's 13 provinces/territories does have some input from federal government and each province goes by standards set by the Canadian Medical Association. Each province or territory has its own provincial health care system run by its own provincial/territorial government and health insurance business, and each province/territory is different from the others with different insurance premiums or taxation systems on its citizens. 

For example, one province's health care system may be paid for by provincial taxes only, another's by federal taxes only (depending on its provincial population), another's is paid for by taxes plus single payer insurance premiums based on a sliding scale in accordance with the insuree's annual income plus size of family, while another province's system may be paid for only by insurance premiums based on income of those working, and by federal taxes for those who are not working. Each one is different and just because a person might have coverage of certain procedures in their own home province doesn't necessarily mean they will have the same coverage for same procedures if needed while they are passing through or visiting in a different province somewhere else in Canada.


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## Fennick (Apr 16, 2013)

watcher said:


> So you have a prime example of how the free market is better than a government controlled one.


Canadians who want expensive non-essential cosmetic surgeries can get it anywhere and by anyone they want at any time they want. They just have to be able to travel for it if necessary, and they have to pay for it out of their own pocket. 

Non-essential cosmetic procedures are not covered but if it is something essential to their good health and well-being then it is covered.


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## watcher (Sep 4, 2006)

Fennick said:


> Yes. You nailed it.
> 
> Wait times in Canada are a result of Canada not having enough medical professionals, nor enough facilities nor medical equipment. Some communities are so isolated they have no health professionals or facilities and patients needing health care have to travel long distances to locations where the services they need are available.


Hum. . .I wonder if someone group might open new facilities and bring in more equipment if they thought they could make money doing it? IOW if you had a capitalist based health care system instead of a socialist based one.




Fennick said:


> What Canada does have is modern and top of the line, there's just not enough of it for Canada's growing population. Add to that, Canada has suffered for a long time from brain drain (other countries tempting Canada's medical graduates away from Canada with promises of more money, more perks, more opportunities, better climate, more chances of fame and glory, etc.).


Hummm. . . might you say the reason there are not enough doctors in Canada is because of government controls? After all if the government allowed demand to set prices then doctors would most likely be less likely to move away to a place just to make money.

I have known two Canadian doctors who left the Canadian health care system because the felt they were not being paid enough for their services.

We have the same problem in the US, a lot of doctors are refusing to take new patients who let the government pay for their health care. That's because the amount the government is willing to pay isn't enough. And hospitals are closing their ER departments because they are required by law to treat anyone who comes in even if they can't, or just won't, pay.


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## Nevada (Sep 9, 2004)

watcher said:


> Hum. . .I wonder if someone group might open new facilities and bring in more equipment if they thought they could make money doing it? IOW if you had a capitalist based health care system instead of a socialist based one.


I'm not sure what you're asking. The Canadian medical system is comprised of private for-profit providers. That would be capitalist based medicine by my definition.


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## watcher (Sep 4, 2006)

Fennick said:


> Canadians who want expensive non-essential cosmetic surgeries can get it anywhere and by anyone they want at any time they want. They just have to be able to travel for it if necessary, and they have to pay for it out of their own pocket.


Don't you wonder why it is such surgeries are cheaper in the US? After all according to a lot of people here we have one of the most expensive and worse ran systems in the world. You'd think people would be fleeing the US to get their medical care rather than coming here. 




Fennick said:


> Non-essential cosmetic procedures are not covered but if it is something essential to their good health and well-being then it is covered.


Sooner or later depending. I find it strange that at least one Canadian province has a website dedicated to finding out how long people will have to wait but every Canadian here seems to be saying that there are no wait times. I wonder where the official 188 day wait time number the Ontario government says there is for shoulder surgery comes from. After all it seems to me its works just like it does in the US. You walk into the doc's office and tell him your shoulder hurts, he sends you down the hall for an MRI then comes in and tells you that you have a 1.5 cm tear in your rotor cuff and if you like you can have the surgery done next week. I guess the wait time comes from people who say they enjoy the pain and tell the doctor to give them over 6 months to have fun before scheduling the op.


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## watcher (Sep 4, 2006)

As my last post shows I'm very confused. Everyone here keeps telling me there are no wait times you just walk in and boom you are shuttled to the OR yet there is a government site which gives the wait times for surgeries and referrals. If there are no 188 day wait times why does the government's official website say there are?


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## Fennick (Apr 16, 2013)

http://healthycanadians.gc.ca/health-system-systeme-sante/cards-cartes/health-role-sante-eng.php

*Provincial/territorial role in health*

The administration and delivery of health care services is the responsibility of each province or territory, guided by the provisions of the Canada Health Act. The provinces and territories fund these services with assistance from the federal government in the form of fiscal transfers.

Health care services include insured primary health care (such as the services of physicians and other health professionals) and care in hospitals, which account for the majority of provincial and territorial health expenditures.

The provinces and territories also provide some groups with supplementary health benefits not covered by the Act, such as prescription drug coverage. The level and scope of coverage for supplementary benefits varies between jurisdictions.
*Provincial/territorial ministries of health*


Provincial/Territorial Health Insurance Card Links
For links to provincial and territorial health ministries, click on your area of residence on the map below *(see map at above link)* or view list of links to provincial/territorial ministries of health.


*Ministries of health*


Alberta.
Health and Wellness

British Columbia.
Ministry of Health Services

Manitoba
Manitoba Health

New Brunswick.
Department of Health

Newfoundland and Labrador.
Health and Community Services

Northwest Territories.
Department of Health and Social Services

Nova Scotia.
Department of Health

Nunavut.
Department of Health and Social Services

Ontario.
Ministry of Health and Long-Term Care

Prince Edward Island.
Department of Health

QuÃ©bec.
SantÃ© et Services Sociaux

Saskatchewan
Saskatchewan Health

Yukon.
Department of Health and Social Service

*Provincial/territorial health insurance card links*


Health cards (also called Care Cards), are a provincial responsibility. For information on how to apply for a health card, click on your province or territory of residence below:

Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon


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## Fennick (Apr 16, 2013)

watcher said:


> As my last post shows I'm very confused. Everyone here keeps telling me there are no wait times you just walk in and boom you are shuttled to the OR yet there is a government site which gives the wait times for surgeries and referrals. If there are no 188 day wait times why does the government's official website say there are?


Please post the link to the official government website that you found.


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## Nevada (Sep 9, 2004)

watcher said:


> As my last post shows I'm very confused. Everyone here keeps telling me there are no wait times you just walk in and boom you are shuttled to the OR yet there is a government site which gives the wait times for surgeries and referrals. If there are no 188 day wait times why does the government's official website say there are?


And I keep hearing that there are no wait times in the USA, but it takes a month to get in to see my primary physician.


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## MO_cows (Aug 14, 2010)

Irish Pixie said:


> My husband has the "very unpleasant procedure" next week and it took 6 weeks. Gasp. There are wait times in the US too!


Mine took several weeks, too, but I held out for a Monday morning appt.


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## Fennick (Apr 16, 2013)

> Originally Posted by *Fennick*
> _Canadians who want expensive non-essential cosmetic surgeries can get it anywhere and by anyone they want at any time they want. They just have to be able to travel for it if necessary, and they have to pay for it out of their own pocket._





watcher said:


> Don't you wonder why it is such surgeries are cheaper in the US? ......


I have never wondered about it. I've always been pretty confident in my opinion that it's because America has so many celebrities and ego-driven and narcissistic people who are obsessed with getting non-essential cosmetic surgeries. When an entire nation has such a high demand from its run of the mill citizens and thousands of celebrities for such non-essential cosmetic services it only makes sense that medical practitioners or insurers will cater to the higher demand with lower prices than some other countries might charge. They lower the prices and that means more people will come for the services not only from the home nation but from around the world. It's a matter of the Joneses striving to keep up with the Smiths to see who can outdo each other in looking most beautiful and glorious. It's a huge industry in USA.


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## wr (Aug 10, 2003)

Do we know it's cheaper to lifted and shifted in the US or are we taking my godmother's word as being factual? If so, I'd be reluctant to use her word as being the final answer because she has to justify her trip to LA. 

She also has her husband convinced that Harrods in London is England's version of Walmart and a Gucci bag is only a couple hundred dollars.


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## Fennick (Apr 16, 2013)

wr said:


> Do we know it's cheaper to lifted and shifted in the US ......


In most cases of non-essential cosmetic surgery I think it probably is cheaper in America. If you look up the prices of breast augmentation as an example (I looked that up because it's such a very common procedure whether it's essential or not) you'd find the average price for an average augmentation in Canada is around $9,000 and in America the average price for average augmentation is $3,000. That's a big difference. If you look up the prices for very high end breast augmentation, it varies between $15,000 to $20,000 in Canada and it's $8,000 to $10,000 in America. Again, a very big difference.

Further to that - there are several thousands of cosmetic practitioners in America, and less than 50 cosmetic practitioners in all of Canada, with Ontario having the most numerous. Some provinces have no cosmetic practitioners at all so people from those provinces would have to travel to another province or out of the country for cosmetic procedures (which WOULD be covered under their health insurance if it's essential, but not covered if it is non-essential).


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## Irish Pixie (May 14, 2002)

MO_cows said:


> Mine took several weeks, too, but I held out for a Monday morning appt.


His was the next available appointment, and was six weeks later. There is either a lot of "roto rooter" work in my area or there are wait times for medical procedures in the US. I'm betting on the latter as there are three decent sized hospitals in the area.


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## watcher (Sep 4, 2006)

Fennick said:


> Please post the link to the official government website that you found.


I thought I had posted it before but here you go:

http://www.health.gov.on.ca/en/public/programs/waittimes/


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## watcher (Sep 4, 2006)

Nevada said:


> And I keep hearing that there are no wait times in the USA, but it takes a month to get in to see my primary physician.


I never said there are no wait times but did you not say that your wait time is self imposed? If my GP told me he would/could not fit me in for a month I'd tell him to gather my records because I'd be in to get them so my new doctor could have them ASAP. 

When I was having pain in my feet I asked friends who had seen a podiatrist if they were happy with him and his treatment of them. Once I decided on the one I wanted to see I called his office and made an appointment. IIRC I was seen the next week. During that office visit he did X-rays (from which I discovered I have a small chunk of metal embedded into my foot which I have no idea when or how it got there) and a sonogram to confirm plantar fasciitis. After it was confirmed he gave me shots and set up an overall treatment plan. So from the time *-=I=-* decided to see a foot specialist until I was treated by one was less than 10 days.


Heck, I can get an appointment with my dentist in less than a month and he's the most difficult medical pro to get an appointment with I have.


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## Bearfootfarm (Jul 13, 2006)

watcher said:


> As my last post shows I'm very confused. Everyone here keeps telling me there are no wait times you just walk in and boom you are shuttled to the OR yet there is a government site which gives the wait times for surgeries and referrals. If there are no 188 day wait times why does the government's official website say there are?


Maybe you're confused because you seem to think every situation is the same when realistically each case is one of a kind


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## watcher (Sep 4, 2006)

Fennick said:


> I have never wondered about it. I've always been pretty confident in my opinion that it's because America has so many celebrities and ego-driven and narcissistic people who are obsessed with getting non-essential cosmetic surgeries. When an entire nation has such a high demand from its run of the mill citizens and thousands of celebrities for such non-essential cosmetic services it only makes sense that medical practitioners or insurers will cater to the higher demand with lower prices than some other countries might charge. They lower the prices and that means more people will come for the services not only from the home nation but from around the world. It's a matter of the Joneses striving to keep up with the Smiths to see who can outdo each other in looking most beautiful and glorious. It's a huge industry in USA.


Another example of how the old capitalistic supply and demand keeps prices low at work.


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## Nevada (Sep 9, 2004)

watcher said:


> If my GP told me he would/could not fit me in for a month I'd tell him to gather my records because I'd be in to get them so my new doctor could have them ASAP.


That assumes that the problem is with the particular doctor's office, not a general shortage of doctors in the community. The doctor shortage in Las Vegas is acute.

_The lack of doctors is particularly acute in the valley. Clark County has just 185 physicians for every 100,000 people, compared with 279 in Washoe County and 346 nationally, according to the University of Nevada School of Medicine._
http://lasvegassun.com/news/2015/jul/20/nevadas-doctor-shortage-affects-clark-county/

Again, you offer a solution without understanding the problem. I've come to expect that.


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## watcher (Sep 4, 2006)

wr said:


> Do we know it's cheaper to lifted and shifted in the US or are we taking my godmother's word as being factual? If so, I'd be reluctant to use her word as being the final answer because she has to justify her trip to LA.
> 
> She also has her husband convinced that Harrods in London is England's version of Walmart and a Gucci bag is only a couple hundred dollars.


You are the one who cited her in one of your discussions, its a basic assumption that your sources are correct. I you doubted her why did you use her data?


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## watcher (Sep 4, 2006)

Bearfootfarm said:


> Maybe you're confused because you seem to think every situation is the same when realistically each case is one of a kind


No I"m confused because its mathematically impossible for the average to be higher than any single data point. If everyone was being treated within a few days there is no way that the average wait time could be 188 days. Unless you had one poor soul who had a really bad doctor and had to wait a couple of decades for an appointment.


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## watcher (Sep 4, 2006)

Nevada said:


> That assumes that the problem is with the particular doctor's office, not a general shortage of doctors in the community. The doctor shortage in Las Vegas is acute.
> 
> _The lack of doctors is particularly acute in the valley. Clark County has just 185 physicians for every 100,000 people, compared with 279 in Washoe County and 346 nationally, according to the University of Nevada School of Medicine._
> http://lasvegassun.com/news/2015/jul/20/nevadas-doctor-shortage-affects-clark-county/
> ...


Something is way wrong here. In one post you say it takes a month to see a doctor but in another you say how you can see a doctor in a matter of hours because of the huge number of walk in clinics. So which is it?


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## Nevada (Sep 9, 2004)

watcher said:


> So from the time *-=I=-* decided to see a foot specialist until I was treated by one was less than 10 days.


My insurance is with an HMO. What that means is that I've assigned a lot of the management of my healthcare to the insurance company in exchange for getting services for low or zero copays. Part of that deal is that a specialist visit is only covered if I get a referral from my primary care doctor.

In an HMO the primary care physician is called the "gatekeeper," since that doctor stands between you and advanced care. The trick is to find a doctor who is quick to refer you to a specialist for problems. My doctor does that.

I can go to a hospital ER or quick care clinic without a referral, but that's about it.


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## farmerDale (Jan 8, 2011)

I never noticed this thread until today, and I never read through it all, but here is my take on our "Free" health care in Canada.

1. It is not even close to free. It is our sky high tax rates that pay into th system.

2. Yes, everyone gets care, sort of.

3. Be prepared to wait, wait, and then wait some more.

4. My sister got scheduled an emergency ct scan on Wednesday. Her date is 10 days from then.

5. It is abused thoroughly. People go in, and waste my money, on the benign. Doctor, I have a sore thumb. Doctor, my pinkie is bleeding. Doctor, my tummy hurts. Doctor, Tommy punched me, and I have a black eye, but I think I have brain damage. There is far too much waste. 

6. For the above reason, I would like to see a 50 dollar a visit fee, to weed out the ridiculous, the wasteful, and the hypochondriacs.

7. I would like a private/public system. Where those who CHOOSE and can afford it, are allowed to do so. This would alleviate a lot of pressure on an overloaded, abused public system.

8. In rural regions, we get the leftovers. We get the doctors who scarcely know english, who do not want to be here, or the ones with questionable practices. The cities skim the cream, we get the sour milk. Important things get brushed off, missed, or skipped over, because rural doctors are often quacks. I believe if a parallel/private system were allowed, more doctors would CHOOSE to come to the rural areas.

Just a few thoughts, on what I see as a far less than stellar system. It is ok, you will get cared for at some point, but it sure could be better. If you need a hip replacement, prepare to wait. If you need an mri, prepare to wait. If you go to the er, prepare to wait at the end of the line, while, a guy with a sniffly nose, a punk kid with pants on the ground playing video games on his phone, and numerous others like them, hog up line...

A good system? Good enough, I guess. Stellar? Not even close. Free? Not even close.


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## Nevada (Sep 9, 2004)

watcher said:


> Something is way wrong here. In one post you say it takes a month to see a doctor but in another you say how you can see a doctor in a matter of hours because of the huge number of walk in clinics. So which is it?


Walk-in quick care clinics and hospital ERs are different. We can usually get seen on an emergency basis quickly. But those doctors only treat the particular problem you came in for, not ongoing health issues.

Walk-in clinics make the system workable, but it's not a solution to the doctor shortage problem. Wait times to see a primary care doctor remain long around here.


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## Nevada (Sep 9, 2004)

farmerDale said:


> A good system? Good enough, I guess. Stellar? Not even close. Free? Not even close.


How do you rate the US medical system?


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## wr (Aug 10, 2003)

watcher said:


> You are the one who cited her in one of your discussions, its a basic assumption that your sources are correct. I you doubted her why did you use her data?



I certainly did cite her but one person's opinion doesn't translate into fact. 

I also stated that she prefers the 5 star hotel environment she's found at a couple clinics in the US but you overlooked that comment. 

Perhaps she justifies her choice because of the personal maid service, lavish meals, Egyptian cotton sheets and spa facilities or maybe she likes the idea of using a surgeon who caters to big name celebrities. 

For all we know, she could have a buy 5 liposuctions, get one free card.


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## Fennick (Apr 16, 2013)

watcher said:


> Another example of how the old capitalistic supply and demand keeps prices low at work.


I guess that's one way of looking at it. In my own opinion it's a different kind of example, of a crime borne out of runaway health care capitalism that I find highly disturbing. 

The reality is it's a type of false health care masquerading as compassionate health care for dupes. It's a capitalist industry that profits by promoting, catering to and taking advantage of a dangerous mental health illness that afflicts multi-millions of emotionally and intellectually unstable self abusers who are encouraged to mutilate themselves through non-essential procedures. If they had never had the option and the encouragement set before them in the first place such self abuse wouldn't be the widespread mental illness it is today in the United States.


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## painterswife (Jun 7, 2004)

farmerDale said:


> I never noticed this thread until today, and I never read through it all, but here is my take on our "Free" health care in Canada.
> 
> 1. It is not even close to free. It is our sky high tax rates that pay into th system.
> 
> ...


I have lived and paid into both systems. I don't think you understand what it costs down here. 

This is for a 56 year old women who has never smoked in the state of Wyoming.

$736.66 per month 4000.00 deductible in network 6500 if you are out of network ( for me across state lines) In other words the nearest specialty hospital. 50% coinsurance for every procedure or appointment. That means I have to hit 6850.00 out of pocket before they cover anything except a yearly physical.

So if I break a bone that requires some minor surgery my total costs in that year is 15700.00 if I get it all in one year. If it happens in Dec. I am way over that because of procedures that could happen in Dec and then the next year. Possibly over 30000.00 More if out of network 

If I have any kind of serious ongoing illness it is 15700.00 every year plus what the cost of my insurance goes up every year. More if my employer decides to up the deductible.

Now that doubles when we include my husband.

If you are younger or lucky enough to be in a area with more people it means it is less but for a couple in their thirties with a couple of kids you are still looking at the 800.00 - 1200.00 per month plus deductibles that are 8000.00 and up.

I know that most people in Canada don't pay enough in extra taxes each year to cover that.


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## watcher (Sep 4, 2006)

Nevada said:


> My insurance is with an HMO. What that means is that I've assigned a lot of the management of my healthcare to the insurance company in exchange for getting services for low or zero copays. Part of that deal is that a specialist visit is only covered if I get a referral from my primary care doctor.
> 
> In an HMO the primary care physician is called the "gatekeeper," since that doctor stands between you and advanced care. The trick is to find a doctor who is quick to refer you to a specialist for problems. My doctor does that.
> 
> I can go to a hospital ER or quick care clinic without a referral, but that's about it.


Ah so your wait time is self imposed. You placed more value on money than the ability to control your health care they way you wish. That's a lot different tune you are now singing now. Before your wait time was because there were not enough doctors for you to get an appointment.


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## Nevada (Sep 9, 2004)

watcher said:


> Ah so your wait time is self imposed. You placed more value on money than the ability to control your health care they way you wish. That's a lot different tune you are now singing now. Before your wait time was because there were not enough doctors for you to get an appointment.


Interestingly, I'm finding 1 to 2 week wait times to see specialists, about half the time it takes to see a primary care doctor.

The HMO deal is too good not to take. Zero copays to see the primary doctor, zero copays to see specialists, zero copays for outpatient surgery, zero copays for tier 1 generic prescriptions, and zero copays for hospital stays. And there is no premium beyond paying the standard Medicare Part B premium. As I said, it's too good not to take it.

[ame]https://www.youtube.com/watch?v=8hLb4Gsa-d0[/ame]

And Senior D doesn't have a "doughnut hole" in the included prescription plan.

[ame]https://www.youtube.com/watch?v=n_O7_FC5jP8[/ame]


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## Bearfootfarm (Jul 13, 2006)

watcher said:


> No I"m confused because *its mathematically impossible for the average to be higher than any single data point*. If everyone was being treated within a few days there is no way that the average wait time could be 188 days. Unless you had one poor soul who had a really bad doctor and had to wait a couple of decades for an appointment.


If you have two "data points" = 1 and 100, the average is* higher *than one and lower than the other. 

I understand your confusion a little better now


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## Fennick (Apr 16, 2013)

watcher said:


> I thought I had posted it before but here you go:
> 
> http://www.health.gov.on.ca/en/public/programs/waittimes/


Thanks. That website isn't for all of Canada, it's for one province, Ontario, which is one of the two most highly populated provinces in Canada (Quebec being the other). 

I couldn't find which hospital location and procedures you were getting Ontario's 188 days wait time for. Didn't see 188 days listed for anything so which hospital and what procedure did you get that wait time for? 

What I found when I looked up MRI's and surgical procedures (for non-life threatening or non-emergency surgeries) for all Ontario hospitals was a maximum wait time of 102 days with an average wait time being around 50 days and some hospitals (and some doctors) have wait times as little as 21 to 28 days, or even no wait times at all. The Ontario government and its provincial health care program is aiming at setting a future target of 28 days maximum wait time for all hospitals in Ontario.

One of the pages on that website had an excellent Q & A page explaining why and what wait times are and how it's established that some people may wait longer than others.


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## wr (Aug 10, 2003)

farmerDale said:


> I never noticed this thread until today, and I never read through it all, but here is my take on our "Free" health care in Canada.
> 
> 1. It is not even close to free. It is our sky high tax rates that pay into th system.
> 
> ...


My local doctor is a very smart man and found a way to bypass those unhappy to be in a rural area and we've ended up with some fine young doctors. 

A certain number of men and women get the medical degrees through the Canadian military, they enlist knowing full well that they may be moved throughout the country and rural ER's usually see a lot of farming and oilfield accidents which are apparently quite similar to combat type injuries so he made an offer the military liked and we've had great doctors ever since. 

Quite a few have come back and set up practice in our area after honoring their obligation for their education.


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## farmerDale (Jan 8, 2011)

Nevada said:


> How do you rate the US medical system?


Well, let me ask you this. Do americans have to sit around for ten days untreated with kidney stone issues, while they wait in line for a ct scan?


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## Fennick (Apr 16, 2013)

farmerDale said:


> Well, let me ask you this. Do americans have to sit around for ten days untreated with kidney stone issues, while they wait in line for a ct scan?


I think your experiences are not representative of Canada's overall health care system nor of all the other provinces and territories individual HC systems nor are they representative of all Canadians. 

Rather, I think they're representative of your own rural location in Saskatchewan, the total population of Saskatchewan (quite small provincial population and not many health care professionals let alone anyone else wants to move to or live in a province like Saskatchewan), the small number of health care professionals and limited facilities in Saskatchewan and Saskatchewan's own provincial government and provincial health care program. 

As mentioned earlier, each province and provincial government has it's own health care program and fee systems separate and independent from all other provinces and none of them are the same as each other for numerous reasons. It sounds like Saskatchewan has problems with its provincial government and its provincial health care programs and fee systems that some of the other provinces don't have. Some provinces do have private health care clinics whereby patients can pay cash (as you suggested you'd like to see available when you made your first post) but apparently Saskatchewan doesn't? Here in my rural town in British Columbia it costs $50 cash for an appointment in a private clinic if the patient is not using their health care card. I don't know how much the private clinics charge for private pay in the big cities but they do accept both private payment or care card. 

I get renal problems frequently because of kidney stones and sometimes in my case because of my senior age renal colic can be life threatening. In my rural location in my own province whenever I have kidney stone related renal colic issues that I deem threatening and painful enough for me to go to the local ER for help I've always been admitted immediately and been treated appropriately and gotten a CT scan within an hour of my admittance to ER. I'm usually passed muster and sent back home within 4 hours of admittance, together with appropriate meds for continuing treatment at home if required.

Whenever I've had to go to an ER in the big city because of kidney stone issues it's usually taken a bit longer, more like 2 to 2.5 hours before I get a CT scan. But appropriate treatment has always started immediately upon admittance and I'm usually out of there and sent home with meds within 7 hours at most. I think it takes longer at the ER's in the big cities simply because of higher city populations and there are more patients waiting in ER's in big city hospitals.


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## wr (Aug 10, 2003)

farmerDale said:


> Well, let me ask you this. Do americans have to sit around for ten days untreated with kidney stone issues, while they wait in line for a ct scan?


I've heard of situations like that and never encountered anything like it until the big guy's doctor took some time off for health reasons. His replacement seemed to just throw everything into the system with no additional comments relating to priorities. 

I do know that your province has had some issues and for a while, certain tests were being done in Alberta but it's my understanding it related to your population density and your provincial government (which we seem to have recently adopted).


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## Nevada (Sep 9, 2004)

farmerDale said:


> Well, let me ask you this. Do americans have to sit around for ten days untreated with kidney stone issues, while they wait in line for a ct scan?


Some do, for economic reasons. You have to include access to care when you rate a healthcare system.


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## fireweed farm (Dec 31, 2010)

farmerDale said:


> I never noticed this thread until today, and I never read through it all, but here is my take on our "Free" health care in Canada.
> 
> 1. It is not even close to free. It is our sky high tax rates that pay into th system.
> 
> ...


The only thing I agree with in your slamming of our healthcare system is I also think a nominal fee may be worthwhile but only for emergency rooms. As soon as you start charging even nominal fees for your family doctor people may think twice about making an appointment, possibly costing the system more when something serious gets missed.

I am also rural and have zero complaints. I also had an emergency CT scan performed for the same reason as your sister- I went into emergency and had one done, in the local clinic within 30-40 mins. Actually we didn't know why I was in pain and that was an emergency. If your sister already has the diagnosis is the CT even an emergency?

FD in your case, and I can only assume you live in the boonies, you have to expect less services and be required to travel for services- due to low population. No private clinic is coming to your area to fill that gap...


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## wr (Aug 10, 2003)

If I were looking for flaws in our system, I would think the biggest issue is limited access to preventative solutions and an emphasis on quick fixes, which is often more invasive and contributes to those waiting lists. 

I can get my ankle rebuilt at no cost to me but I have to pay for physiotherapy. I can get big drugs for my migraines but I have to pay my chiropractor who gives me as much relief with less side effects. 

My father could have surgery for Meniere's, which is considered a short term solution but he had to pay for the acupuncturist that has left him symptom free for years after three visits. 

My mother removed herself from the waiting list for gallbladder surgery completely, when she realized she could control the situation by modifying her diet.


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## fireweed farm (Dec 31, 2010)

It could be better but it's pretty darn good. 

In Canada the average family of 4 spends $11,320 per year with no deductibles or company's or other fees. 

What does the same pay in the US once you include the added fees? I'm assuming more because you have whole industries making up the middle man?


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## farmerDale (Jan 8, 2011)

wr said:


> I've heard of situations like that and never encountered anything like it until the big guy's doctor took some time off for health reasons. His replacement seemed to just throw everything into the system with no additional comments relating to priorities.
> 
> I do know that your province has had some issues and for a while, certain tests were being done in Alberta but it's my understanding it related to your population density and your provincial government (which we seem to have recently adopted).


The kidney stone thing is in regards to my sister who lives in the city of Saskatoon. My mom waited for TWO years to get pins in her feet. While she waited, she could scarcely walk. 

My main trouble with our goofy health care system, is the unreal wait times. It is just silly.


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## farmerDale (Jan 8, 2011)

fireweed farm said:


> The only thing I agree with in your slamming of our healthcare system is I also think a nominal fee may be worthwhile but only for emergency rooms. As soon as you start charging even nominal fees for your family doctor people may think twice about making an appointment, possibly costing the system more when something serious gets missed.
> 
> I am also rural and have zero complaints. I also had an emergency CT scan performed for the same reason as your sister- I went into emergency and had one done, in the local clinic within 30-40 mins. Actually we didn't know why I was in pain and that was an emergency. If your sister already has the diagnosis is the CT even an emergency?
> 
> FD in your case, and I can only assume you live in the boonies, you have to expect less services and be required to travel for services- due to low population. No private clinic is coming to your area to fill that gap...


I live in the boonies, yes, (thank you Lord!), but my sister lives IN SASKATOON. Yes she needs a ct scan because they need to see what they are dealing with, as the stone has not passed in almost 2 weeks now. And she waits. In our largest city. For help.

When I got booked in for my scan a few years back, I waited in the er for at least 6 hours, behind mr. pants on the ground video gamer, and the other folks with no visible pain.

I would have been more than happy to pay 500 bucks let alone 50, to have the freedom to get treated in a timely manner. 

I am truly surprised that other Canadians have not had waiting issues. Canada ranks around 54th in wait times apparently. That is mainly what is so sad about our "free" health care system.


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## wr (Aug 10, 2003)

farmerDale said:


> The kidney stone thing is in regards to my sister who lives in the city of Saskatoon. My mom waited for TWO years to get pins in her feet. While she waited, she could scarcely walk.
> 
> My main trouble with our goofy health care system, is the unreal wait times. It is just silly.


It's goofy in the sense that there are wild swings from one province to another. 

I'm one of those people that believes surgery should be a last resort so when my youngest cut his hand, I found it foolish to haul him off for surgery because he might have a kinked finger. I also felt it foolish to haul him off to have his hand pinned when he had sustained a 'boxers' break in a bike accident because it was going to heal anyhow. Both were ordered by an ER doctor and they were intending to schedule within 3 hours. 

I knew my ankle would heal slowly but I'm not a marathon runner so I felt that it was best if I let mother nature do her job and leave the OR open for someone in more need. 

I've also seen doctors schedule surgery with multiple surgeons in order to get an elective patient the first available opportunity but all that does is gum up the system for folks like your family members.

I am aware that there was a time, that quite a few Saskatchewan patients were being sent to Alberta for MRI's and CT scans because your own was so backed up.


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## wr (Aug 10, 2003)

farmerDale said:


> When I got booked in for my scan a few years back, I waited in the er for at least 6 hours, behind mr. pants on the ground video gamer, and the other folks with no visible pain.


I can't speak to Mr. Pants on the Ground but when my youngest went in for his CT scan, he had no obvious pain either but in his case, the lungs have no pain receptors but he darned sure needed the scan and the resulting surgeries. 

I was actually surprised at how quickly that all happened but the only people that felt they were qualified to remove a fencing staple embedded in a grapefruit sized mass of scar tissue was a funny area of pulmonary oncology, who developed a procedure to extend the lives of patients for a few more weeks. Perhaps it was because of the type of specialty or he may have gotten lucky but again, he sat in the our doctors office while they called surgeons together and actually had to ask that his appointment delayed a day because he had to work that afternoon.


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## Nevada (Sep 9, 2004)

farmerDale said:


> I never noticed this thread until today, and I never read through it all, but here is my take on our "Free" health care in Canada.


Say what you will about single payer health care, but at the end of the day Canadians live 3 years longer than people in the US. Why do you suppose that is?


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## tiffnzacsmom (Jan 26, 2006)

The only doctor's office in my county is open two days a week with rotating doctors there is no being seen the next day unless you drive 45 minutes away for most of us. The only urgent cares are attached to hospitals and have limited hours. If you need a specialist but not actively dying you can drive an hour and a half each way and maybe get in within a month.


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## wr (Aug 10, 2003)

tiffnzacsmom said:


> The only doctor's office in my county is open two days a week with rotating doctors there is no being seen the next day unless you drive 45 minutes away for most of us. The only urgent cares are attached to hospitals and have limited hours. If you need a specialist but not actively dying you can drive an hour and a half each way and maybe get in within a month.


I'm actually right in the middle of two towns (30 minutes either way) and my doctor works 3 days a week at one and two days at the other and I really like both of his associates. Our records are stored electronically so if I really needed to see a doctor and Bob wasn't available, I have access to doctors that he and I both trust and they have access to my files.


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## farmerDale (Jan 8, 2011)

Nevada said:


> Say what you will about single payer health care, but at the end of the day Canadians life 3 years longer than people in the US. Why do you suppose that is?


Could be any number of things. Less obesity, more fresh air, cleaner water, cleaner air, more space, better diet, fewer military deaths, fewer african americans. I can guarantee you it is not our health care. There is a reason Canadians rush to the Mayo clinic in droves for some stellar service when no one here can help them out when bad news strikes.

And I am talking merely about giving Canadians choice. The choice to buy their health care and take the pressure of the over-rated, over used, and highly abused public system.

I would love the choice myself. But this is Canada. We western Canadian farmers, for example, only a few years ago gained the right to sell our own wheat and barley. Some things just stick for decades, no matter how lame and abusive they are.


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## Nevada (Sep 9, 2004)

farmerDale said:


> Could be any number of things. Less obesity, more fresh air, cleaner water, cleaner air, more space, better diet, fewer military deaths, fewer african americans. I can guarantee you it is not our health care. There is a reason Canadians rush to the Mayo clinic in droves for some stellar service when no one here can help them out when bad news strikes.
> 
> And I am talking merely about giving Canadians choice. The choice to buy their health care and take the pressure of the over-rated, over used, and highly abused public system.
> 
> I would love the choice myself. But this is Canada. We western Canadian farmers, for example, only a few years ago gained the right to sell our own wheat and barley. Some things just stick for decades, no matter how lame and abusive they are.


The fact is that it's not just Canada. People who live in the UK and even France (they love their wine & cheese) live longer than we do. It just seems that we're not getting our money's worth, particularly when people in the US pay twice as much per capata than Canadians do for healthcare.

The price is high, the results are not great, and lots of US citizens are still without healthcare insurance. We have to start doing better.


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## keenataz (Feb 17, 2009)

farmerDale said:


> Could be any number of things. Less obesity, more fresh air, cleaner water, cleaner air, more space, better diet, fewer military deaths, fewer african americans. I can guarantee you it is not our health care. There is a reason Canadians rush to the Mayo clinic in droves for some stellar service when no one here can help them out when bad news strikes.
> 
> And I am talking merely about giving Canadians choice. The choice to buy their health care and take the pressure of the over-rated, over used, and highly abused public system.
> 
> I would love the choice myself. But this is Canada. We western Canadian farmers, for example, only a few years ago gained the right to sell our own wheat and barley. Some things just stick for decades, no matter how lame and abusive they are.


I have lived for 57 years ,in different Provinces and I have never known or heard any Canadian rushing to the Mayo clinic. I'm sure there are some but not a heck of a lot. 

Not a perfect system but I'll take it over the US and do do the majority of Canadians.


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## farmerDale (Jan 8, 2011)

keenataz said:


> I have lived for 57 years ,in different Provinces and I have never known or heard any Canadian rushing to the Mayo clinic. I'm sure there are some but not a heck of a lot.
> 
> Not a perfect system but I'll take it over the US and do do the majority of Canadians.


I know many, many people who went down to the mayo clinic, because waiting was life or death. Do you have a problem though, with the choice that we should have available, but do not? It is the grand irony that we are forced to bow to a take it or leave it health care system. I simply want choice.


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## fireweed farm (Dec 31, 2010)

Nevada said:


> Say what you will about single payer health care, but at the end of the day Canadians live 3 years longer than people in the US. Why do you suppose that is?


I was going to mention that, plus our lower infant mortality rate. The "big stuff" IMO.
Both Canada and the EU beat the US here.


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## fireweed farm (Dec 31, 2010)

farmerDale said:


> I know many, many people who went down to the mayo clinic, because waiting was life or death. Do you have a problem though, with the choice that we should have available, but do not? It is the grand irony that we are forced to bow to a take it or leave it health care system. I simply want choice.


BC has a few private clinics that include surgical options- consider moving West? Or cheap tix with Westjet?
I know we have our differences but I bet we'd have plenty to laugh about in person.


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## Nevada (Sep 9, 2004)

farmerDale said:


> I would love the choice myself. But this is Canada.


But, of course, you have a choice. You could leave Canada. Evidently there's something about Canada that works for you.

I tell people the same when they remark that the generous HMO I have in Las Vegas isn't available in their area. I suggest that they relocate to Vegas, which isn't generally received very well.


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## fireweed farm (Dec 31, 2010)

FD once mentioned here that he tears up when he hears the star spangled banner so perhaps a move south is exactly the prescription?


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## Nevada (Sep 9, 2004)

fireweed farm said:


> FD once mentioned here that he tears up when he hears the star spangled banner so perhaps a move south is exactly the prescription?


Actually, we don't have a lot of choice here either. One way or another, we're usually boxed-in economically. You can only select plans you can afford, so the decision of what plan to get is pretty much made for you.


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## Farmerga (May 6, 2010)

Nevada said:


> Actually, we don't have a lot of choice here either. One way or another, we're usually boxed-in economically. You can only select plans you can afford, so the decision of what plan to get is pretty much made for you.


Prior to the ACA I had a list as long as my arm, of choices. Now, I am not allowed to even get a catastrophic policy for ~$100 a month. Now that same or worse policy costs ~$500 a month and is called a "Bronze plan". The plan I do have has gone up 50% and is still the cheapest for the money. Co-pays have gone up, but, even though I have had the ole snip snip, I am still covered for BC. Gee, thanks Obama.


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## Nevada (Sep 9, 2004)

Farmerga said:


> Prior to the ACA I had a list as long as my arm, of choices. Now, I am not allowed to even get a catastrophic policy for ~$100 a month. Now that same or worse policy costs ~$500 a month and is called a "Bronze plan". The plan I do have has gone up 50% and is still the cheapest for the money. Co-pays have gone up, but, even though I have had the ole snip snip, I am still covered for BC. Gee, thanks Obama.


In the first place, the insurance policies aren't the same as they used to be before the ACA. ACA compliant policies can't be canceled and they have to accept everyone, regardless of preexisting conditions. There was no insurance like that before the ACA.

There seems to be an idea that if you can't afford premiums for better insurance plans that catastrophic plans are a low-cost alternative. But the truth is that if you can't afford higher premiums that you also can't afford the higher copays of catastrophic plans. If you have a 30% copay and have a $400K heart attack, you'll need to come up with $120K yourself. If a copay that large drives you into bankruptcy, you might as well not have insurance at all.

Saving money with a catastrophic plan is false economy.


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## farmerDale (Jan 8, 2011)

fireweed farm said:


> FD once mentioned here that he tears up when he hears the star spangled banner so perhaps a move south is exactly the prescription?


lol. Nah, I like my country and my province, and my farm far too much to leave it. I just want choice for Canadians who want it. Fought my entire farming career for the same rights for western farmers as those east of the MB/ON border. We finally got that right, after 70 years of second class status. I hope we get the same right to choice in health care. I fail to see why this is such a big deal. To simply ask for the right to buy health care? 

A parallel system is all I would like to see. It would alleviate wait times and poor service. A small fee for each visit to weed out the abusers. Not a huge deal, IMO.

Yes, I have been known to tear up when an anthem is sung. Especially at remembrance day/veterans day time. I appreciate what our countries fought against together.


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## farmerDale (Jan 8, 2011)

fireweed farm said:


> BC has a few private clinics that include surgical options- consider moving West? Or cheap tix with Westjet?
> I know we have our differences but I bet we'd have plenty to laugh about in person.


I don't take differences in most things too seriously, and I agree, we would chuckle a lot.


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## Farmerga (May 6, 2010)

Nevada said:


> In the first place, the insurance policies aren't the same as they used to be before the ACA. ACA compliant policies can't be canceled and they have to accept everyone, regardless of preexisting conditions. There was no insurance like that before the ACA.
> 
> There seems to be an idea that if you can't afford the premiums for better insurance plans that catastrophic plans are a low-cost alternative. But the truth is that if you can't afford higher premiums that you also can't afford the higher copays of catastrophic plans.
> 
> ...


I used to be able to find plans that would pay for nothing up to $15 or $20,000 then pay for everything. The idea being that the insurance company wouldn't be nickeled and dimed for every little sniffle, but, would be there when something rare, and bad happened. Paying $20,000 out of a $400,000 bill would not cause the average person to go bankrupt.


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## painterswife (Jun 7, 2004)

farmerDale said:


> lol. Nah, I like my country and my province, and my farm far too much to leave it. I just want choice for Canadians who want it. Fought my entire farming career for the same rights for western farmers as those east of the MB/ON border. We finally got that right, after 70 years of second class status. I hope we get the same right to choice in health care. I fail to see why this is such a big deal. To simply ask for the right to buy health care?
> 
> A parallel system is all I would like to see. It would alleviate wait times and poor service. A small fee for each visit to weed out the abusers. Not a huge deal, IMO.
> 
> Yes, I have been known to tear up when an anthem is sung. Especially at remembrance day/veterans day time. I appreciate what our countries fought against together.


I get what you are asking for. I am sure you are aware of the reasons that others will fight hard against this.

I am curious how you would suggest it work? The two systems side by side.


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## Nevada (Sep 9, 2004)

Farmerga said:


> The idea being that the insurance company wouldn't be nickeled and dimed for every little sniffle


It's not about unnecessarily dinging the insurance company for small issues, it's a bout the high cost of routine care. I remember the day when it cost $20 to see a doctor. Those days are gone, with primary care doctor visits over $100 and specialist visits over $200. People found themselves in the position of not taking their kids to a doctor in a timely matter because of office visit cost.

The idea of insurance covering routine care is to normalize the cost of doctor visits over the year. You pay a little more each month, but you don't get slammed with $200 doctor visits when you aren't expecting it. There's nothing evil about that concept.


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## fireweed farm (Dec 31, 2010)

farmerDale said:


> I don't take differences in most things too seriously, and I agree, we would chuckle a lot.


I neglected to mention I have plenty of room to crash and would make it avail.


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## Farmerga (May 6, 2010)

Nevada said:


> It's not about unnecessarily dinging the insurance company for small issues, it's a bout the high cost of routine care. I remember the day when it cost $20 to see a doctor. Those days are gone, with primary care doctor visits over $100 and specialist visits over $200. People found themselves in the position of not taking their kids to a doctor in a timely matter because of office visit cost.
> 
> The idea of insurance covering routine care is to normalize the cost of doctor visits over the year. You pay a little more each month, but you don't get slammed with $200 doctor visits when you aren't expecting it. There's nothing evil about that concept.


 Have you ever thought as to why the $20 doctor visit is gone? Government interference along with unrealistic expectations of insurance companies have made our HC costs skyrocket. Those two things have taken the law of supply and demand out of the picture. Who cares if the doctor charges 3, 4, or $500 as long as you only pay $25?


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## wr (Aug 10, 2003)

Alberta tried a universal $25 user fee and it made a huge mess. People with chronic health problems ended up being hit hard and quite a few thrifty folks delayed going to the doctor, which cost us more by way of missing early detection of serious health problems. 

I personally feel that a lot of hospitals would benefit from running a walk in clinic alongside ER's so non emergencies could be treated as non emergencies without wasting ER time and resources.


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## fireweed farm (Dec 31, 2010)

painterswife said:


> I get what you are asking for. I am sure you are aware of the reasons that others will fight hard against this.
> 
> I am curious how you would suggest it work? The two systems side by side.


I believe it's already happening to a small extent, always in and out of the courts but they seem to be working out from what I gather. 
I'm not sure but think it's pay by usage, with all the scans and surgeries seem to be available at the clinics, athletes and people with money seem to be the main clients. The clients would still be paying into the national healthcare taxes but it's quite low so if you've got the money affordable to do both. 
Many don't like the idea of the two tier system, I myself am happy with the service I get fromthe regular system and wouldn't likely pay for private care


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## Nevada (Sep 9, 2004)

wr said:


> I personally feel that a lot of hospitals would benefit from running a walk in clinic alongside ER's so non emergencies could be treated as non emergencies without wasting ER time and resources.


It works. University Medical Center in Las Vegas does that. The triage nurse in the ER directs appropriate cases to the UMC Quick Care clinic, while more serious cases are directed to the ER.


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## MO_cows (Aug 14, 2010)

Nevada said:


> In the first place, the insurance policies aren't the same as they used to be before the ACA. ACA compliant policies can't be canceled and they have to accept everyone, regardless of preexisting conditions. There was no insurance like that before the ACA.
> 
> There seems to be an idea that if you can't afford premiums for better insurance plans that catastrophic plans are a low-cost alternative. *But the truth is that if you can't afford higher premiums that you also can't afford the higher copays of catastrophic plans.* If you have a 30% copay and have a $400K heart attack, you'll need to come up with $120K yourself. If a copay that large drives you into bankruptcy, you might as well not have insurance at all.
> 
> Saving money with a catastrophic plan is false economy.


Wrong. People who don't have a lot of income, but do have savings or assets, were a perfect fit for the old "catastrophic" plans. And how is 70% or $280,000 towards your bill not better than having no insurance at all????


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## farmerDale (Jan 8, 2011)

painterswife said:


> I get what you are asking for. I am sure you are aware of the reasons that others will fight hard against this.
> 
> I am curious how you would suggest it work? The two systems side by side.



I actually am not really sure why other people would want to stifle it. Many use the excuse that they are poor and so they are second class somehow. But here is why I believe it would work and work well. When maybe 30% of the population, choose to pay for more rapid service, the other 70%, get to jump ahead 30%, because there is that much less pressure and need for the public system. It is self balancing this way. Once pressure is removed from the public system, it should be that much better.


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## farmerDale (Jan 8, 2011)

fireweed farm said:


> I neglected to mention I have plenty of room to crash and would make it avail.


We have a pile of cousins and so on in B.C., but I appreciate the gesture!

:grin:


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## farmerDale (Jan 8, 2011)

The really funny thing about this, is I am not a wealthy man at all, and I probably could not even afford to use the private system. Yet I advocate for it, based on the principle of CHOICE.


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## Nevada (Sep 9, 2004)

MO_cows said:


> Wrong. People who don't have a lot of income, but do have savings or assets, were a perfect fit for the old "catastrophic" plans. And how is 70% or $280,000 towards your bill not better than having no insurance at all????


Because from an individual standpoint, the bill is still not paid and the individual still declares bankruptcy. In practice, people didn't give up their savings & assets for a medical bill. The thing is that medical bills are considered by the courts to be unsecured assets, which are generally discharged during bankruptcy.

Remember, bankruptcy isn't just a way to discharge debts, it's to protect assets. You can discharge debt without bankruptcy just by letting the statute of limitations expire. After that there is no legal remedy to collect those debts.

Anyone with his head screwed on straight will declare bankruptcy before allowing a medical bill to strip him of his savings & assets. That exactly what a lawyer will tell you too.


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## painterswife (Jun 7, 2004)

farmerDale said:


> I actually am not really sure why other people would want to stifle it. Many use the excuse that they are poor and so they are second class somehow. But here is why I believe it would work and work well. When maybe 30% of the population, choose to pay for more rapid service, the other 70%, get to jump ahead 30%, because there is that much less pressure and need for the public system. It is self balancing this way. Once pressure is removed from the public system, it should be that much better.


Is that what really happens? Please note I am not against this I would just want to know more of how things would work. Will more doctors move to the private system and cause further waits in the public system? Are the two systems commingled or completely separate?


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## farmerDale (Jan 8, 2011)

painterswife said:


> Is that what really happens? Please note I am not against this I would just want to know more of how things would work. Will more doctors move to the private system and cause further waits in the public system? Are the two systems commingled or completely separate?


Very good question. I think some doctors would be driven and would shift over to private clinics. I think many would not. It is hard enough being a doctor, let alone running a business as well. Collect the big paydays, and continue on as we are. 

The two systems would have to have the same regulations, in that both would need to be hiring competent staff. But from what I see of the public system, it is failing at this miserably in some ways as it is now. I think medical records etc. would need to be shared between both systems. 

Lots would have to be worked out. I am but a simple farmer, I am not entirely positive on some aspects of the dual system. :drum:


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## MO_cows (Aug 14, 2010)

Nevada said:


> Because from an individual standpoint, the bill is still not paid and the individual still declares bankruptcy. In practice, people didn't give up their savings & assets for a medical bill. The thing is that medical bills are considered by the courts to be unsecured assets, which are generally discharged during bankruptcy.
> 
> Remember, bankruptcy isn't just a way to discharge debts, it's to protect assets. You can discharge debt without bankruptcy just by letting the statute of limitations expire. After that there is no legal remedy to collect those debts.
> 
> Anyone with his head screwed on straight will declare bankruptcy before allowing a medical bill to strip him of his savings & assets. That exactly what a lawyer will tell you too.


Well of course that is what the lawyer will advise you. He makes his money from the bankruptcy filing and proceeding. But not everyone believes in weaseling out of their debts with a bankruptcy. And not everyone has a $400k heart attack either. The early health insurance policies were all "catastrophic" type policies, only back then it was called "hospitalization". People expected to pay out of pocket for their day to day needs, but if they did end up with a huge medical bill, the insurance would kick in and help. 

A choice for insurance that was working perfectly well for a lot of people was eliminated by the ACA. You can spin it any way you want to, that's the bottom line.


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## Nevada (Sep 9, 2004)

MO_cows said:


> A choice for insurance that was working perfectly well for a lot of people was eliminated by the ACA. You can spin it any way you want to, that's the bottom line.


I would like to learn more about the consequences of catastrophic health insurance. How much did they pay in premiums, how much did they get in benefits, how many went bankrupt, etc.


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## MO_cows (Aug 14, 2010)

Nevada said:


> I would like to learn more about the consequences of catastrophic health insurance. How much did they pay in premiums, how much did they get in benefits, how many went bankrupt, etc.


It's a moot point now. They are gone. 

I imagine some of the less than brilliant crowd bought the cheapest monthly premium insurance, then had a huge health event with huge bills they couldn't pay, and cried foul to anyone who would listen over their own shortsightedness. So the government has now saved them from themselves, and at the same time screwed everybody else who was using the policies properly, the became collateral damage. Sound about right?


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## sisterpine (May 9, 2004)

Personally, I do not think there is any perfect way to handle health care for millions of people. Some people will always require more health care resources than others and some folks will not be able or even willing to pay for their own health care so the system needs to be paid somehow. All those sayings about charity beginning at home and carrying ones brother/sister etc all came from someplace. Most of the religions I am familiar with stress helping those less fortunate than ourselves and I believe there is ALWAYS some one less fortunate than each of us. In the days before big government folks got sick and some of them died or became seriously disabled. Now days a person is disabled sometimes for merely having broken a bone many years ago. This is a very complicated issue. Overhead for obtaining a medical degree, building a hospital/clinic etc are very high and thus we are all asked to help pay for the same. I know I am just rambling...


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## watcher (Sep 4, 2006)

Bearfootfarm said:


> If you have two "data points" = 1 and 100, the average is* higher *than one and lower than the other.
> 
> I understand your confusion a little better now


Ok another example why I should not post when I'm short on sleep. I meant that the average can be higher than ALL the data points. Everyone here keeps saying that their waiting time was a few days but the average, according to the government's data, is almost 200 days. If there are so many people being seen in days there must be one or two poor suckers out there who have been waiting for a decade that have skewed the data set.


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## wr (Aug 10, 2003)

watcher said:


> Ok another example why I should not post when I'm short on sleep. I meant that the average can be higher than ALL the data points. Everyone here keeps saying that their waiting time was a few days but the average, according to the government's data, is almost 200 days. If there are so many people being seen in days there must be one or two poor suckers out there who have been waiting for a decade that have skewed the data set.


Unfortunately, you're getting comments from Canadians in every province and each one of our health care systems is a bit different than the other. 

What happens in Alberta is different than Saskatchewan or BC and those three will be different than Ontario. 

I realize that you think it's an unworkable system but it's difficult to explain how it works or why it works to someone who's not using it and ultimately, no Canadian is trying to convince you that the US needs to adopt our system.


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## watcher (Sep 4, 2006)

Fennick said:


> Thanks. That website isn't for all of Canada, it's for one province, Ontario, which is one of the two most highly populated provinces in Canada (Quebec being the other).
> 
> I couldn't find which hospital location and procedures you were getting Ontario's 188 days wait time for. Didn't see 188 days listed for anything so which hospital and what procedure did you get that wait time for?


Go to the site, pick adult wait times, orthopedic surgery, shoulder surgery and choose any hospital. The "Provincial Wait Time " will be at the top above the wait time for the hospital you picked. The "target " for the wait time will also be listed, 182 days. So I guess the plan is to have people wait six months before surgery. 

I also just noticed it says that 9 out of 10 will have their surgeries done in this time so its not what you'd call an average wait time. It seems strange to me to list it that way. I can find no info on how they actually calculate the wait time. The way I read it if 8 people get their surgery done within a week, the 9th has to wait 188 days and 10th has to wait 1,000 days the "Provincial Wait Time" would still be 188 days because 90% of the ops were done within that time. OTOH that 10th person could only have to wait 189 days. So the true average wait time could be longer or shorter than that number. I have to wonder if they use this system because it some how allows them to post a shorter wait time. Like the US calculates the unemployment numbers.




Fennick said:


> What I found when I looked up MRI's and surgical procedures (for non-life threatening or non-emergency surgeries) for all Ontario hospitals was a maximum wait time of 102 days with an average wait time being around 50 days and some hospitals (and some doctors) have wait times as little as 21 to 28 days, or even no wait times at all. The Ontario government and its provincial health care program is aiming at setting a future target of 28 days maximum wait time for all hospitals in Ontario.


The 102 number is the "Provincial Wait Time". So while someone is getting their MRI in 28 days someone somewhere is waiting a LOT longer to get that provincial time up that high.


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## watcher (Sep 4, 2006)

Nevada said:


> Some do, for economic reasons. You have to include access to care when you rate a healthcare system.


That makes no sense. There's a very large difference between not having a service available and not being to access it. You could have tens of thousands of dollars in the bank it and it wouldn't do you a bit of good if your appendix ruptures on your yacht in the middle of the Pacific.

I've never met a doctor who would not work with someone who needed medical care but didn't have much money.


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## Nevada (Sep 9, 2004)

watcher said:


> That makes no sense. There's a very large difference between not having a service available and not being to access it. You could have tens of thousands of dollars in the bank it and it wouldn't do you a bit of good if your appendix ruptures on your yacht in the middle of the Pacific.
> 
> I've never met a doctor who would not work with someone who needed medical care but didn't have much money.


Nevertheless, the World Health Organization gives the USA low marks on access to medical care. You don't rate a healthcare system on the way the wealthy are treated, you rate it on how everyone is treated.


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## watcher (Sep 4, 2006)

Nevada said:


> Say what you will about single payer health care, but at the end of the day Canadians live 3 years longer than people in the US. Why do you suppose that is?


Better eating habits, different view of personal freedoms, fewer auto accidents, fewer young males being raised w/o a father figure, colder average temperatures, none of those, all of those, who knows.


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## watcher (Sep 4, 2006)

Nevada said:


> The fact is that it's not just Canada. People who live in the UK and even France (they love their wine & cheese) live longer than we do. It just seems that we're not getting our money's worth, particularly when people in the US pay twice as much per capata than Canadians do for healthcare.
> 
> The price is high, the results are not great, and lots of US citizens are still without healthcare insurance. We have to start doing better.


When it comes to health care its the government's job to make sure the care offered is safe and works as advertised and that's all. Its not its job to make sure you as in individual gets any care you want nor even need. 

The same applies to food, housing, jobs and more.


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## Nevada (Sep 9, 2004)

watcher said:


> When it comes to health care its the government's job to make sure the care offered is safe and works as advertised and that's all. Its not its job to make sure you as in individual gets any care you want nor even need.


Federal law (the ACA) says otherwise.


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## watcher (Sep 4, 2006)

Nevada said:


> In the first place, the insurance policies aren't the same as they used to be before the ACA. ACA compliant policies can't be canceled and they have to accept everyone, regardless of preexisting conditions. There was no insurance like that before the ACA..


 That's because its no longer insurance if you are already sick. You can't get insurance to rebuild a house that is already on fire, repair a car that has already been wrecked nor a boat that is already sinking why should you be able to get insurance to cover cancer treatments AFTER you discover you have cancer?




Nevada said:


> There seems to be an idea that if you can't afford premiums for better insurance plans that catastrophic plans are a low-cost alternative. But the truth is that if you can't afford higher premiums that you also can't afford the higher copays of catastrophic plans. If you have a 30% copay and have a $400K heart attack, you'll need to come up with $120K yourself. If a copay that large drives you into bankruptcy, you might as well not have insurance at all.


 That's one of the nasty little secrets those who shoved obamacare down our throats either kept hidden or lied about. If people had known they'd be forced at the point of a financial bayonet to pay for something they could never use they would have flooded congress with phone calls, emails and bodies.

As with most thing coming out of DC obamacare was not passed to help anyone other than the pols themselves.




Nevada said:


> Saving money with a catastrophic plan is false economy.


Not always true. Back when I was young and didn't have kids I only carried catastrophic coverage. Young people in good physical condition very rarely need to visit a doctor which means the money they save by not carrying "full coverage" is better spent else where. 

Of course I think back then catastrophic plans were different. Those only covered specific items and/or only kicked in after X number of dollars were spent on one problem. Those specific things (auto accidents, cancer, etc.) were covered 100%


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## watcher (Sep 4, 2006)

Nevada said:


> It's not about unnecessarily dinging the insurance company for small issues, it's a bout the high cost of routine care. I remember the day when it cost $20 to see a doctor. Those days are gone, with primary care doctor visits over $100 and specialist visits over $200. People found themselves in the position of not taking their kids to a doctor in a timely matter because of office visit cost.
> 
> The idea of insurance covering routine care is to normalize the cost of doctor visits over the year. You pay a little more each month, but you don't get slammed with $200 doctor visits when you aren't expecting it. There's nothing evil about that concept.


 And you used to be able to buy a hamburger for a dime, those days are gone as well. Should we have hamburger insurance to provide hamburgers at a dime each?

Also how much of the added cost is from government regs and insurance? Every doctor's office I've been into in the last decade has had at least one employee who did nothing but deal with insurance issues. If you have to pay your own bill then get reimbursed by the insurance company I'd be willing to bet cost would go down. One, because people would see the real cost of their treatment and most likely shop around and two, because the doctor would be able to reduce his staff and thereby overhead cost.


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## Nevada (Sep 9, 2004)

watcher said:


> That's because its no longer insurance if you are already sick. You can't get insurance to rebuild a house that is already on fire, repair a car that has already been wrecked nor a boat that is already sinking why should you be able to get insurance to cover cancer treatments AFTER you discover you have cancer?


The idea was that if everyone is covered, forcing insurance companies to accept everyone (including heart & cancer patients) would work. In general that's true and workable.

But the ACA has an interesting feature; the open enrollment period. Each autumn, subscribers to exchange policies can change to any plan offered in their area. So if someone on a bronze or silver plan gets diagnosed with cancer, what's stopping him from signing up with the best platinum plan available? Nothing, and they can't refuse to take him as a customer. So why won't all cancer patients do that? After all, they know they'll use the coverage. Heck, their doctor can even give them an estimate of costs for surgery, chemo and radiation.

I'm waiting to see how that feature plays out.


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## arabian knight (Dec 19, 2005)

watcher said:


> And you used to be able to buy a hamburger for a dime, those days are gone as well. Should we have hamburger insurance to provide hamburgers at a dime each?
> 
> Also how much of the added cost is from government regs and insurance? Every doctor's office I've been into in the last decade has had at least one employee who did nothing but deal with insurance issues. If you have to pay your own bill then get reimbursed by the insurance company I'd be willing to bet cost would go down. One, because people would see the real cost of their treatment and most likely shop around and two, because the doctor would be able to reduce his staff and thereby overhead cost.


Lets see this fall how many MORE drop out of that Uncare obama crud. Already 1.5 Million have THIS YEAR. Ya its so good people are LEAVING. LOL


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## Nevada (Sep 9, 2004)

arabian knight said:


> Lets see this fall how many MORE drop out of that Uncare obama crud. Already 1.5 Million have THIS YEAR. Ya its so good people are LEAVING. LOL


USA Today reports that enrollment increased by 4 million in 2016.

_Nearly 13 million people signed up for health insurance ahead of the Jan. 31 deadline for 2016 on the state and federal exchanges, federal health officials said Thursday._
_The numbers represent an increase of 4 million new people enrolled in the 38 states using HealthCare.gov._
http://www.usatoday.com/story/news/...lion-people-enrolled-aca-plans-2016/79828268/


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## watcher (Sep 4, 2006)

Nevada said:


> The idea was that if everyone is covered, forcing insurance companies to accept everyone (including heart & cancer patients) would work. In general that's true and workable.


 It only works if you also FORCE individual citizens to buy insurance no matter if they want it or not. If a company is forced to cover you AFTER you are sick why in the world would you waste money buying coverage BEFORE you get sick? Would you spend hundreds or thousands of dollars on home insurance if you knew an insurance company would be forced by the government to pay to replace if you waited to pay for insurance until AFTER it burned? 




Nevada said:


> But the ACA has an interesting feature; the open enrollment period. Each autumn, subscribers to exchange policies can change to any plan offered in their area. So if someone on a bronze or silver plan gets diagnosed with cancer, what's stopping him from signing up with the best platinum plan available? Nothing, and they can't refuse to take him as a customer. So why won't all cancer patients do that? After all, they know they'll use the coverage. Heck, their doctor can even give them an estimate of costs for surgery, chemo and radiation.
> 
> I'm waiting to see how that feature plays out.


Its simple, it will lead to higher insurance rates and to more insurance companies refusing play in a rigged game. Both of which will lead to what the pols want, government control of the entire health care industry because it gives the power and control over people.


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## watcher (Sep 4, 2006)

Nevada said:


> USA Today reports that enrollment increased by 4 million in 2016.
> 
> _Nearly 13 million people signed up for health insurance ahead of the Jan. 31 deadline for 2016 on the state and federal exchanges, federal health officials said Thursday._
> _The numbers represent an increase of 4 million new people enrolled in the 38 states using HealthCare.gov._
> http://www.usatoday.com/story/news/...lion-people-enrolled-aca-plans-2016/79828268/


More and more are going to start realizing its foolish to pay more for insurance that they will never be able to use than it is to pay the fine. . .ah tax for not having insurance at all. Simple math tells you its better to pay a $500 fine. . .tax than $1,500 for an insurance policy which requires you to spend $8,000 before it even kicks in. If you could afford to pay $8K for medical cost you could afford to buy insurance BEFORE obamacare was in place.


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## arabian knight (Dec 19, 2005)

*CBO Slashes 2016 Obamacare Exchange Enrollment Projections By 8 Million*

Ah geez someone forgot to add that~! Just uses the 13 million number instead of how many it had to Decrease the amount by. 20 million SLASHED downward to 13 million that is a HUGE DROP in projected sign ups now. LOL




> The new CBO numbers come three months after the White House threw in the towel on meaningful exchange enrollment growth, predicting that the exchanges would stall at around 10.4 million enrollees in 2016: an increase of only 1.3 million from the previous year.


 And ONLY went up a small amount of 1.3 million from the previous year, wow now how can that be IF this thing called Obamacare is sooooo good??? And 1.5 million have been dropped because of Non Payment of premiums. LOL


http://www.forbes.com/sites/theapothecary/2016/01/26/cbo-slashes-2016-obamacare-exchange-enrollment-projections-by-8-million/#3df7b1e7791e


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## Nevada (Sep 9, 2004)

watcher said:


> If a company is forced to cover you AFTER you are sick why in the world would you waste money buying coverage BEFORE you get sick?


Because there's a penalty tax if you don't buy coverage.


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## Nevada (Sep 9, 2004)

watcher said:


> More and more are going to start realizing its foolish to pay more for insurance that they will never be able to use than it is to pay the fine. . .ah tax for not having insurance at all.


Most are preferring to carry insurance. There's value in having coverage, but no value in paying a fine.


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## Fennick (Apr 16, 2013)

farmerDale said:


> ..... A parallel system is all I would like to see. It would alleviate wait times and poor service. A small fee for each visit to weed out the abusers. Not a huge deal, IMO.......





painterswife said:


> I am curious how you would suggest it work? The two systems side by side.





farmerDale said:


> ....... But here is why I believe it would work and work well. When maybe 30% of the population, choose to pay for more rapid service, the other 70%, get to jump ahead 30%, because there is that much less pressure and need for the public system. It is self balancing this way. Once pressure is removed from the public system, it should be that much better.





painterswife said:


> Is that what really happens? Please note I am not against this I would just want to know more of how things would work. *Will more doctors move to the private system and cause further waits in the public system?* Are the two systems commingled or completely separate?


That's the thing I'm curious about.

The real problem causing wait times in Canada is that: 

(a) there are not enough medical professionals in Canada
(b) there are not enough medical facilities in Canada
(c) there are not enough medical equipments in Canada

How will having two systems motivate more medical professionals to immigrate to Canada and/or motivate more medical graduates to stay in Canada?

Who will be building and paying the costs for new medical facilities to be built in the places where they're needed?

Who will be paying to have new medical equipments installed in the new facilities?

Last but not least - Canadians are not wealthy people. The majority of Canada's population is middle class people who rely on the system presently in place. Who will be using the private pay system? Certainly not the middle class or those in the low income brackets. That doesn't leave very many people using the system who can afford it, since there are not many wealthy people in Canada and those who are very wealthy can afford to go to USA or Europe for their specialized treatments that aren't available in Canada (due to lack of specialists). Not many wealthy people do go out of the country for medical care as it is now anyway since they are already paying into a system that works well for them.

So where is all the money going to come from for new medical professionals to be brought in to Canada, for new facilities and new equipment to cater to wealthy people who want to pay privately? I guess it will have to be the wealthy people who pay for it but it won't make any difference to the wait times for people who can't afford what wealthy people can afford.


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## Nevada (Sep 9, 2004)

watcher said:


> That makes no sense. There's a very large difference between not having a service available and not being to access it. You could have tens of thousands of dollars in the bank it and it wouldn't do you a bit of good if your appendix ruptures on your yacht in the middle of the Pacific.
> 
> I've never met a doctor who would not work with someone who needed medical care but didn't have much money.


Maybe you've never heard of patient dumping.

[ame]https://www.youtube.com/watch?v=jeGFIL4BD_M[/ame]


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## watcher (Sep 4, 2006)

Nevada said:


> Because there's a penalty tax if you don't buy coverage.


But the fine. . .ah tax is lower than the insurance prices. You'd still be saving money.


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## watcher (Sep 4, 2006)

Nevada said:


> Most are preferring to carry insurance. There's value in having coverage, but no value in paying a fine.


Depends. If you have a choice of paying a $500 fine or $1,500 for insurance you won't use you are saving $1,000 by paying the fine.


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## watcher (Sep 4, 2006)

Nevada said:


> Maybe you've never heard of patient dumping.


Sure I have, it happens every day in ERs. They treat a person, because they are required by law, then dump them out the door with a script and recommendation to see a doctor.


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## Nevada (Sep 9, 2004)

watcher said:


> But the fine. . .ah tax is lower than the insurance prices. You'd still be saving money.


But with the fine you wouldn't have insurance. As I said, carrying insurance has value.


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## Farmerga (May 6, 2010)

Nevada said:


> Because there's a penalty tax if you don't buy coverage.


My tax preparer showed me what my penalty would have been if I didn't have insurance. It was no where even close to the amount I paid in premiums.


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## Nevada (Sep 9, 2004)

watcher said:


> Sure I have, it happens every day in ERs. They treat a person, because they are required by law, then dump them out the door with a script and recommendation to see a doctor.


That would be true if the patient was stable enough to release with a prescription and a recommendation to see a doctor, but only if the patient is stable.

Under the Emergency Medical Treatment and Active Labor Act (EMTALA), in addition to screening and treating the patient without regard to ability to pay, they must also stabilize the condition or transfer the patient to another medical facility which can provide appropriate care.

http://takingcareofmomanddad.com/hospitals/reportingproblems/antidumpinglaw.html

In the City of Los Angeles patient dumping is also a criminal offense.

_In a California Healthline Special Report, city officials from Los Angeles and a vice president of the Hospital Association of Southern California discussed recent cases of âpatient dumpingâ and a new law making the practice a crime._
http://californiahealthline.org/new...-1-million-settlement-new-law-in-los-angeles/


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## Nevada (Sep 9, 2004)

Farmerga said:


> My tax preparer showed me what my penalty would have been if I didn't have insurance. It was no where even close to the amount I paid in premiums.


But having insurance is a good thing. You must think so too or you wouldn't have it.


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## watcher (Sep 4, 2006)

Nevada said:


> But with the fine you wouldn't have insurance. As I said, carrying insurance has value.


A Rolls-Royce has value but if you spent so much to buy it that you can't afford to buy gas to drive it is it any use to you?


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## Nevada (Sep 9, 2004)

watcher said:


> A Rolls-Royce has value but if you spent so much to buy it that you can't afford to buy gas to drive it is it any use to you?


That the great thing about the ACA, if you can't afford healthcare insurance you will qualify for a subsidy.


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## watcher (Sep 4, 2006)

Nevada said:


> That would be true if the patient was stable enough to release with a prescription and a recommendation to see a doctor, but only if the patient is stable.
> 
> Under the Emergency Medical Treatment and Active Labor Act (EMTALA), in addition to screening and treating the patient without regard to ability to pay, they must also stabilize the condition or transfer the patient to another medical facility which can provide appropriate care.
> 
> ...


There in lies the problem and why you see more and more hospitals closing their ERs. You can't stay in business if you are forced to provide your service free of charge. 

Look it this way. Say you ran a store front computer store and the government required you to provide "emergency" computer repair to anyone who walked in to your ECR department, no matter if they could pay you or not. How much money do you think you'd lose in a year because people knew they could come in, demand you fix their computer then walk away w/o paying?

And once you had provided them service you were required to continue to do so until you 'transferred' them to another repair center. How easy do you think its going to be to find another repair center to accept them knowing they can not, or just will not, pay for their service? Change the story to say you don't provide ECR in your repair shot, would you take on someone as a client who has already shown they can't pay for your service?


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## Nevada (Sep 9, 2004)

watcher said:


> There in lies the problem and why you see more and more hospitals closing their ERs.


That hasn't happened around here.

The only case I can think of was the ER in Tonopah, NV last year, but that's extremely remote and was never intended to operate at a profit.


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## mreynolds (Jan 1, 2015)

OK, haven't read through all this. But here's what I know from the hospitals I have built and heard from the administrators on. 

Last two hospitals I built both admins said they wanted the OR floor done first. The last one said it generates 1 million a day. Just one floor mind you out of 6 floors. So we finished that floor first and worked on the other 5 while they were doing surgery. The ER floor was next as it was the next most money generator (10 million month even with indigent care included). Then the private rooms and then the dbl rooms then the offices. 

Now this OR floor generated 30 million a month in a city pop. 50k. The entire job was 78 million for all six floors. I finished six months _early on this floor_(as per their requests). 

30 million a month paid out 180 million which was twice the entire job. The job was paid for before it was even completed. 

Tell me again how hospitals in America are losing money? 

And then lets talk about why insurance is so high here.


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## mreynolds (Jan 1, 2015)

watcher said:


> There in lies the problem and why you see more and more hospitals closing their ERs. You can't stay in business if you are forced to provide your service free of charge.
> 
> Look it this way. Say you ran a store front computer store and the government required you to provide "emergency" computer repair to anyone who walked in to your ECR department, no matter if they could pay you or not. How much money do you think you'd lose in a year because people knew they could come in, demand you fix their computer then walk away w/o paying?
> 
> And once you had provided them service you were required to continue to do so until you 'transferred' them to another repair center. How easy do you think its going to be to find another repair center to accept them knowing they can not, or just will not, pay for their service? Change the story to say you don't provide ECR in your repair shot, would you take on someone as a client who has already shown they can't pay for your service?


We have two hospitals in my town. Haven't built on any of those and don't know anyone there except the county hospital that I Used to work under as an EMT. The county hospital gets a certain amount from the county for indigent care. I think last year was around 3 mill. They say its not enough. 

But they managed to add on with a 100 million reno last year for some reason. ALL indigent care goes there as the other turns them away if *the injury is not life threatening. * That is the key there. It has to be life threatening and then all they have to _legally_ do is sustain that injury and then ship them off to county.


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## mreynolds (Jan 1, 2015)

Nevada said:


> Federal law (the ACA) says otherwise.


Yet the WHO still rates us as low. whoduthunkit?


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## Nevada (Sep 9, 2004)

mreynolds said:


> Yet the WHO still rates us as low. whoduthunkit?


We would rate a lot better if we had single payer.


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## no really (Aug 7, 2013)

Nevada said:


> We would rate a lot better if we had single payer.


I agree on that, get rid of "health insurers", all they are insuring is their prosperity.


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## Nevada (Sep 9, 2004)

no really said:


> I agree on that, get rid of "health insurers", all they are insuring is their prosperity.


Insurance isn't a bad thing, but a 20% overhead is pretty steep. That effectively increases the cost of all medical care by 20%. If it can be done for less the way Medicare is run then we'll all be better off.


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## no really (Aug 7, 2013)

Nevada said:


> Insurance isn't a bad thing, but a 20% overhead is pretty steep. That effectively increases the cost of all medical care by 20%. If it can be done for less the way Medicare is run then we'll all be better off.


When you discuss costs for the individual in Medicare there should also be discussion of gap insurance. 

I like the Canadian style health care, with ours there is the huge insurers whose only interest is profit.


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## MO_cows (Aug 14, 2010)

Nevada said:


> Insurance isn't a bad thing, but a 20% overhead is pretty steep. That effectively increases the cost of all medical care by 20%. If it can be done for less the way Medicare is run then we'll all be better off.


20% isn't overhead, it is overhead + profit. ACA dictated that 80% of income has to be spent on care. The remaining 20% is their overhead and profit both. And I bet those insurance companies are pretty good at keeping their overhead down so more of it is profit. They have lots of incentive to do so, unlike the federal government.


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## Nevada (Sep 9, 2004)

no really said:


> When you discuss costs for the individual in Medicare there should also be discussion of gap insurance.


I don't think about it. Since I have Medicare Advantage I'm not eligible for any kind of supplemental insurance. But my HMO is generous enough that I don't need it. Heck, we don't even have a doughnut hole.


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## mreynolds (Jan 1, 2015)

MO_cows said:


> 20% isn't overhead, it is overhead + profit. ACA dictated that 80% of income has to be spent on care. The remaining 20% is their overhead and profit both. And I bet those insurance companies are pretty good at keeping their overhead down so more of it is profit. They have lots of incentive to do so, unlike the federal government.


You beat me to it. Another thing to consider is hospital oh/p. Service type business usually have to charge in the 30's and above because there is no set income on the balance sheets. Therefore they have to charge more.


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## Nevada (Sep 9, 2004)

mreynolds said:


> You beat me to it. Another thing to consider is hospital oh/p. Service type business usually have to charge in the 30's and above because there is no set income on the balance sheets. Therefore they have to charge more.


There's way too much profit in medicine. I suspect it will never go away in this country. I don't see Americans settling for government-provided medical services like the do in England. Government insurance is one thing, but medical service is another.


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## Farmerga (May 6, 2010)

Nevada said:


> But having insurance is a good thing. You must think so too or you wouldn't have it.


I believe that wearing a seatbelt is a good thing, but, I wouldn't force my opinion on others and do fight for the repeal of seatbelt laws, even though I wouldn't think of riding in a car without one. Same with helmet laws, raw milk laws, drug laws, and all of the other laws that force us to or not to do something "for our own good".


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## keenataz (Feb 17, 2009)

Farmerga said:


> I believe that wearing a seatbelt is a good thing, but, I wouldn't force my opinion on others and do fight for the repeal of seatbelt laws, even though I wouldn't think of riding in a car without one. Same with helmet laws, raw milk laws, drug laws, and all of the other laws that force us to or not to do something "for our own good".


But what happens when you get sick or injured by not following these laws. Then it become society's problem to pay the cost

This is not directed at you, but anyone in general.


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## Farmerga (May 6, 2010)

keenataz said:


> But what happens when you get sick or injured by not following these laws. Then it become society's problem to pay the cost
> 
> This is not directed at you, but anyone in general.


Why? You takes your chances, you pays your money. 

That is a dangerous precedent to take. That opens up all sorts of excuses to illegalize all sorts of things. (I feel that the drive for government to "take care of us" is a ruse to accomplish just that)

Lets make it illegal to eat X, Y, or, Z, because they may cause heart disease, stroke, obesity, etc. and that costs society.

Lets make it illegal to drive, because auto injuries cost society. 

Lets make it illegal to this and that and that and this because it may cost something in the long run. 

Lets take all of the guns away because they cost society.

Lets illegalize yelling because it causes stress and that costs society.

Lets illegalize fun because you might get hurt and that costs society.

Lets limit the number of children you can have because that costs society.

I could go on and some of these are silly. ( I used to think it silly that government might force me to buy a product from a private company, but, I ain't laughing anymore)


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## keenataz (Feb 17, 2009)

Yes I agree it could be taken to absurd levels. I think the key is it rationale and does it really infringe on a person. In my opinion wearing a seat belt or helmet meets that standard. 

The examples you give, although at least the healthy eating one makes sense but not practical would not meet that test. And no I'm not a good nazi as I am sitting here eating m&ms


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## JeffreyD (Dec 27, 2006)

keenataz said:


> But what happens when you get sick or injured by not following these laws. Then it become society's problem to pay the cost
> 
> This is not directed at you, but anyone in general.


Why would it be society's problem, what happened to personal responsibility?


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## Farmerga (May 6, 2010)

keenataz said:


> Yes I agree it could be taken to absurd levels. I think the key is it rationale and does it really infringe on a person. In my opinion wearing a seat belt or helmet meets that standard.
> 
> The examples you give, although at least the healthy eating one makes sense but not practical would not meet that test. And no I'm not a good nazi as I am sitting here eating m&ms


 See that is the problem. What is rational to you may not be rational to others and vice versa. Mine is a more concrete rationale, if the act is not likely to directly harm others, the individual should be free to engage in said act. It is simple and concrete.


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## Nevada (Sep 9, 2004)

JeffreyD said:


> Why would it be society's problem, what happened to personal responsibility?


When everyone is treated it becomes the government's responsibility, because the government ends up paying for it. The more we contribute to our healthcare the less the government has to pay. The ACA was all about getting us to contribute more to our healthcare.


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## mreynolds (Jan 1, 2015)

Nevada said:


> There's way too much profit in medicine. I suspect it will never go away in this country. I don't see Americans settling for government-provided medical services like the do in England. Government insurance is one thing, but medical service is another.


This is true and I gave an example of it. But why do I (I have an HSA) pay less when I pay out of pocket for my deductible than when they charge the insurance. One reason is because insurance doesn't like to pay and drag it out over several months. So hospitals and Drs charge extra for the late payment. Another reason is that yes, there is fraud in the medical field. 

So if there were no insurance at all would prices go down? They would have to for them to be competitive. Otherwise we would go somewhere else and get treated. 

I don't know what the answer is just what I know so far from my little corner of the world.


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## MO_cows (Aug 14, 2010)

keenataz said:


> But what happens when you get sick or injured by not following these laws. Then it become society's problem to pay the cost
> 
> This is not directed at you, but anyone in general.


It is "society's problem" when people are born with Down's Syndrome, are genetically predisposed to different cancers and diseases, etc. 

When we became a civilization and formed societies, we made a pact to take care of the weaker ones and gave up the "survival of the fittest" strategy of the animal kingdom.


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## Nevada (Sep 9, 2004)

mreynolds said:


> So if there were no insurance at all would prices go down? They would have to for them to be competitive. Otherwise we would go somewhere else and get treated.


How would that work with no insurance? If someone had a heart attack and needed a $400,000 bypass procedure, would lowering the price really help? Could the average family pay $350K, $300K, or even $200K? Probably not.

Without insurance to pay for expensive procedures, those expensive procedures would cease to exist. The medical system we have today would collapse. Medicine would revert to the state it was in 50 years ago. People would routinely die from treatable disorders.


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## Farmerga (May 6, 2010)

MO_cows said:


> It is "society's problem" when people are born with Down's Syndrome, are genetically predisposed to different cancers and diseases, etc.
> 
> When we became a civilization and formed societies, we made a pact to take care of the weaker ones and gave up the "survival of the fittest" strategy of the animal kingdom.


Does that pact include subsidizing the stupidity of others? It is one thing to help pay for the cancer victim or child with Downs, it is another to pay for the person who drank himself into liver disease.


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## Farmerga (May 6, 2010)

Nevada said:


> How would that work with no insurance? If someone had a heart attack and needed a $400,000 bypass procedure, would lowering the price really help? Could the average family pay $350K, $300K, or even $200K? Probably not.
> 
> Without insurance to pay for expensive procedures, those expensive procedures would cease to exist. The medical system we have today would collapse.


 If few could pay for the procedure, would not the cost reduce to a level where they could pay? What are the real costs of the procedure? What does the equipment cost to produce? What do the consumables cost to produce? What is the time of the Doctors and support staff run? Truth be known, the procedure really doesn't cost $400,000, or, anything even in the ball park. That is what the hospitals charge to dance the dance with the insurance companies. Get rid of the Insurance and much of the government meddling, and prices will plummet.


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## keenataz (Feb 17, 2009)

MO_cows said:


> It is "society's problem" when people are born with Down's Syndrome, are genetically predisposed to different cancers and diseases, etc.
> 
> When we became a civilization and formed societies, we made a pact to take care of the weaker ones and gave up the "survival of the fittest" strategy of the animal kingdom.


I think you misinterpret what I mean. I am one who believe that we as a society should help.

My point was by not wearing a seat belt or helmet a person is putting themselves at risk which is preventable. and by doing that could sustain a major injury which if happens may not be able to pay for. Which would result in someone else have to pay for. I'm not saying we shouldn't, but rather selfish on that individual when it is a preventable risk.

And yes I know bad things still happen when wearing safety equipment.


----------



## Nevada (Sep 9, 2004)

Farmerga said:


> If few could pay for the procedure, would not the cost reduce to a level where they could pay? What are the real costs of the procedure? What does the equipment cost to produce? What do the consumables cost to produce? What is the time of the Doctors and support staff run? Truth be known, the procedure really doesn't cost $400,000, or, anything even in the ball park. That is what the hospitals charge to dance the dance with the insurance companies. Get rid of the Insurance and much of the government meddling, and prices will plummet.


Maybe. They do it a lot cheaper in India.

http://www.bloomberg.com/news/artic...gery-in-india-for-1-583-costs-106-385-in-u-s-


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## JeffreyD (Dec 27, 2006)

Nevada said:


> When everyone is treated it becomes the government's responsibility, because the government ends up paying for it. The more we contribute to our healthcare the less the government has to pay. The ACA was all about getting us to contribute more to our healthcare.


Then treat no one. The aca is abject failure for most except for you. Here in California, their billions short and not paying doctors. Doctors are also not accepting medicare/medical because of non payment. Now what?

Its ones own responsibility to take care of themselves, not some whom they have never met. To think that someone else should be liable for their poor decisions is beyond comprehension.


----------



## JeffreyD (Dec 27, 2006)

Nevada said:


> Maybe. They do it a lot cheaper in India.
> 
> http://www.bloomberg.com/news/artic...gery-in-india-for-1-583-costs-106-385-in-u-s-


Move there. Your problem is solved!


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## Nevada (Sep 9, 2004)

JeffreyD said:


> Move there. Your problem is solved!


My problem was already solved. I'm on a Medicare HMO with no copay for hospital stays.

But I've been a long-time advocate of overseas medical tourism.


----------



## JeffreyD (Dec 27, 2006)

Nevada said:


> My problem was already solved. I'm on a Medicare HMO with no copay for hospital stays.
> 
> But I've been a long-time advocate of overseas medical tourism.


But you don't have to pay, someone else does. Why do you feel that it's ok for someone else to pay for *YOUR* healthcare and not cover it yourself? Are you not responsible for your own life? What if the government defaults, like Greece, Spain, Portugal, etc...


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## mreynolds (Jan 1, 2015)

Nevada said:


> How would that work with no insurance? If someone had a heart attack and needed a $400,000 bypass procedure, would lowering the price really help? Could the average family pay $350K, $300K, or even $200K? Probably not.
> 
> Without insurance to pay for expensive procedures, those expensive procedures would cease to exist. The medical system we have today would collapse. Medicine would revert to the state it was in 50 years ago. People would routinely die from treatable disorders.


Well, I have an HSA. So in essence I am self insured. The coverage I do have is for surgeries just like that. Funny thing is, I now have a lower deductible than the others have. But I have been putting money back tax free to cover my deductible. 


Let me put this in engineers terms since I know you understand that well. 

Two machines. Da Vinci heart machine and a CNC router for a metal shop. Both cost about the same but if I need gussets for a truss it doesn't cost me 400,000 dollars to get them. Now it takes a week to get them done but heart surgery is one day. 

The difference is competition and honest trade.


----------



## Nevada (Sep 9, 2004)

JeffreyD said:


> But you don't have to pay, someone else does. Why do you feel that it's ok for someone else to pay for *YOUR* healthcare and not cover it yourself? Are you not responsible for your own life? What if the government defaults, like Greece, Spain, Portugal, etc...


I had to pay. I paid for Medicare during my working life.

Admittedly, SS & Medicare are both important to me. But in addition to my Chevron retirement, I own my home mortgage-free and have a respectable pile of silver bar. If need be, I can work online doing IT work. I'll get by.


----------



## watcher (Sep 4, 2006)

keenataz said:


> But what happens when you get sick or injured by not following these laws. Then it become society's problem to pay the cost
> 
> This is not directed at you, but anyone in general.


Society maybe but NOT the governments problem nor job.

If you wish to pay for your neighbor's medical care go right ahead. If you do not wish to pay for it your other neighbors have no right to force you pay.


----------



## watcher (Sep 4, 2006)

Nevada said:


> When everyone is treated it becomes the government's responsibility, because the government ends up paying for it. The more we contribute to our healthcare the less the government has to pay. The ACA was all about getting us to contribute more to our healthcare.


Why is the government paying to take care of individuals?


----------



## watcher (Sep 4, 2006)

Nevada said:


> How would that work with no insurance? If someone had a heart attack and needed a $400,000 bypass procedure, would lowering the price really help? Could the average family pay $350K, $300K, or even $200K? Probably not.
> 
> Without insurance to pay for expensive procedures, those expensive procedures would cease to exist. The medical system we have today would collapse. Medicine would revert to the state it was in 50 years ago. People would routinely die from treatable disorders.


Simple but harsh. If you can't pay for a bypass procedure then you don't get one. If you gamble with your life by not having insurance there's a chance you are going to roll snake-eyes.


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## Nevada (Sep 9, 2004)

watcher said:


> Simple but harsh. If you can't pay for a bypass procedure then you don't get one.


Letting Americans die for lack of medical treatment is an undesirable outcome. I think we can do better.


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## Farmerga (May 6, 2010)

Nevada said:


> Letting Americans die for lack of medical treatment is an undesirable outcome. I think we can do better.


 Advocate for a way to do it without force of government, and I will stand with you.


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## Nevada (Sep 9, 2004)

Farmerga said:


> Advocate for a way to do it without force of government, and I will stand with you.


I doubt that's possible. The alternative to government administrated insurance is charity, but there just aren't enough charitable resources available. I don't think there ever can be enough charitable resources to do the job. As I pointed out before, it's not unusual for a family to pay $1,000/month for health insurance, but a $1,000/month charitable contribution would be extraordinarily large. You can't expect charity to accomplish what insurance accomplishes.


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## Farmerga (May 6, 2010)

Nevada said:


> I doubt that's possible. The alternative to government administrated insurance is charity, but there just aren't enough charitable resources available. I don't think there ever can be enough charitable resources to do the job. As I pointed out before, it's not unusual for a family to pay $1,000/month for health insurance, but a $1,000/month charitable contribution would be extraordinarily large. You can't expect charity to accomplish what insurance accomplishes.


Yes, but, without insurance and government over meddling, the costs would be so reduced that charity could pick up the slack. 

Government has never really been able to run anything well and almost never under budget.


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## Nevada (Sep 9, 2004)

Farmerga said:


> Yes, but, without insurance and government over meddling, the costs would be so reduced that charity could pick up the slack.


Medical procedures are expensive to the point where they just aren't possible without insurance. Without insurance the demand for expensive lifesaving procedures would evaporate for the most part, and businesses that offered those procedures would cease to exist. That would be bad for the economy, bad for the medical industry, and bad for the American people.


----------



## Farmerga (May 6, 2010)

Nevada said:


> Medical procedures are expensive to the point where they just aren't possible without insurance. Without insurance the demand for expensive lifesaving procedures would evaporate for the most part, and businesses that offered those procedures would cease to exist. That would be bad for the economy, bad for the medical industry, and bad for the American people.


 With the exception for artificial manipulation, as technology and knowledge increases, the price of said tech decreases. Again look at Lasik. The machines and expertise for said procedures are expensive, yet, as it is not paid for by insurance, the price has been steadily going down. Look at cell phones, computers, etc. Calculators, that would have sold for well over $100 in the 70's, are given away as business cards today. 

A million dollar machine that can be used for 1000 procedures isn't all that expensive. A Doctor's time, even at $500 an hour would be a few thousand dollars. It is insurance that causes these procedures to be so expensive. There is a lot of room there for the market to work its magic.


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## Nevada (Sep 9, 2004)

Farmerga said:


> With the exception for artificial manipulation, as technology and knowledge increases, the price of said tech decreases.


True, but we're talking about going back to the way things were in the 50s & 60s, back before we had bypass surgery or cures for cancer.

Before bypass surgery all the could do was load you up on morphine and wait to see if you lived or died. Morphine is cheap compared to a $400K bypass procedure. Regardless of how much the price of bypass comes down, it will never be a inexpensive as morphine.

The last time people could get by without health insurance was in the 50s & 60s. It's just not realistic to go back to that time. The medical procedures are here now.


----------



## Farmerga (May 6, 2010)

Nevada said:


> True, but we're talking about going back to the way things were in the 50s & 60s, back before we had bypass surgery or cures for cancer.
> 
> Before bypass surgery all the could do was load you up on morphine and wait to see if you lived or died. Morphine is cheap compared to a $400K bypass procedure. Regardless of how much the price of bypass comes down, it will never be a inexpensive as morphine.
> 
> The last time people could get by without health insurance was in the 50s & 60s. It's just not realistic to go back to that time. The medical procedures are here now.


No, we are letting the free market work. There is the technology and the expertise for these new procedures. Without insurance, the costs will not go down some, or, be cut in half, they will plummet to a level where the majority of people can pay. Why? Because that is supply and demand. These machines and medications will not sit by and collect dust because they can't get $400,000 per procedure. They will take what the market will bear, and they will make money.


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## Nevada (Sep 9, 2004)

Farmerga said:


> No, we are letting the free market work. There is the technology and the expertise for these new procedures. Without insurance, the costs will not go down some, or, be cut in half, they will plummet to a level where the majority of people can pay. Why? Because that is supply and demand. These machines and medications will not sit by and collect dust because they can't get $400,000 per procedure. They will take what the market will bear, and they will make money.


You're missing the fact that people willingly went to insurance in the early 1970s because a cash & carry medical system wasn't working for them. It became a necessity and everyone knew it.

You're suggesting that we try something new; living without health insurance. But it's not new. We've already been there and it wasn't working.


----------



## JeffreyD (Dec 27, 2006)

Nevada said:


> You're missing the fact that people willingly went to insurance in the early 1970s because a cash & carry medical system wasn't working for them. It became a necessity and everyone knew it.
> 
> You're suggesting that we try something new; living without health insurance. But it's not new. We've already been there and it wasn't working.


Well, it worked well for me and tens of millions of others! :shrug:


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## Jim Bunton (Mar 16, 2004)

Unless you are wealthy it only worked well for you as long as you didn't have any major medical problems or the government forced hospitals to treat emergency patients and then subsidized hospitals for doing it. Then hospitals over charged patients who could pay or had insurance to make up the difference. That is how the old system worked. 

Jim


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## MO_cows (Aug 14, 2010)

Jim Bunton said:


> Unless you are wealthy it only worked well for you as long as you didn't have any major medical problems or the government forced hospitals to treat emergency patients and then subsidized hospitals for doing it. Then hospitals over charged patients who could pay or had insurance to make up the difference. That is how the old system worked.
> 
> Jim


It still works that way. We still have uninsured and everbody else pays more to cover them. Also most doctors have a limit for how many Medicare and Medicaid patients they will take, and the rest of their patients pay more to offset those.


----------



## Laura Zone 5 (Jan 13, 2010)

itsb said:


> we all know that o-boma care is a huge disaster, but what about our neighbors to the north in Canada,dont they some sort of health care and if so how does it work and how do you rate it


OBAMA CARE
I am on the hook for the first 7400.00

2400. in premiums (Silver)
5000. in deductibles.

I made 29,000.00 last year.

THAT IS 25% OF MY ANNUAL INCOME.
Your mortgage/rent cannot be more than 30% of your annual income.
So 55% of your annual income is for a roof over your head and lousy worthless healthcare?

WHY can't people see Americans were straight up lied too. 
Just lied too......


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## Nevada (Sep 9, 2004)

Laura Zone 5 said:


> OBAMA CARE
> I am on the hook for the first 7400.00
> 
> 2400. in premiums (Silver)
> ...


You didn't have an HMO available? Sounds like it would be worth your while to go back and look for one. What's your postal zip code?


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## 1948CaseVAI (May 12, 2014)

Laura Zone 5 said:


> OBAMA CARE
> I am on the hook for the first 7400.00
> 
> 2400. in premiums (Silver)
> ...



Everything that stinking [person] says is a lie. I never thought I had the capacity to hate as much as I hate that lying [].


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## mreynolds (Jan 1, 2015)

Nevada said:


> You didn't have an HMO available? Sounds like it would be worth your while to go back and look for one. What's your postal zip code?



In my experience HSA's work better. Lower deductible and _*so far*_ not prohibited. Choose your own Dr. But the ACA will probably find a way to do away with it because it works.


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## Nevada (Sep 9, 2004)

mreynolds said:


> In my experience HSA's work better. Lower deductible and _*so far*_ not prohibited. Choose your own Dr. But the ACA will probably find a way to do away with it because it works.


HMO plans usually don't have a deductible for routine services (doctor visits, labs, etc.). The Medicare HMO plan I'm not now has no deductible at all.

We get to choose our primary care doctor, but it has to be a doctor in their network. My doctor happened to be in their plan.


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## JeffreyD (Dec 27, 2006)

Jim Bunton said:


> Unless you are wealthy it only worked well for you as long as you didn't have any major medical problems or the government forced hospitals to treat emergency patients and then subsidized hospitals for doing it. Then hospitals over charged patients who could pay or had insurance to make up the difference. That is how the old system worked.
> 
> Jim


Wasn't wealthy, but it still worked great for our whole family. Not now.


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## Jim Bunton (Mar 16, 2004)

JeffreyD said:


> Wasn't wealthy, but it still worked great for our whole family. Not now.


So are you saying you had major medical problems and payed for them out of pocket? 


Why isn't it working for you now? It is a maximum fine of $975, if you can pay for major medical problem I wouldn't think that would sink you.

I have insurance for the first time in my adult life thanks to Obama care. If I am careful to stick with in network providers it isn't bad insurance. I had a previous condition that drove costs out of reach before.

Jim


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## mreynolds (Jan 1, 2015)

Nevada said:


> HMO plans usually don't have a deductible for routine services (doctor visits, labs, etc.). The Medicare HMO plan I'm not now has no deductible at all.
> 
> We get to choose our primary care doctor, but it has to be a doctor in their network. My doctor happened to be in their plan.


Agree someone on Medicare doesn't need an HSA but a person working I would recommend it highly. If you have two years no sickness your deductible would be covered. Plus all your dr visits come right off deductible and you can see nay Dr or specialist you want. Period. Plus my deductible is only 2500/year. Two years tax free taken out of my check and that's all covered. Plus when I retire that money is still mine. I can use it for my Medicare deductible. 

With a self directed HSA you can invest the money how ever you want to make it grow including buy silver with it.


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## Nevada (Sep 9, 2004)

mreynolds said:


> Agree someone on Medicare doesn't need an HSA but a person working I would recommend it highly.


My Medicare HMO isn't a whole lot different from Obamacare HMO plans. In fact my Medicare HMO is underwritten by the same company that was underwriting my Obamacare HMO before I was 65.

HMOs aren't for everyone, but I save a fortune. I saw my doctor yesterday with zero copay. I like that.


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## JeffreyD (Dec 27, 2006)

Jim Bunton said:


> So are you saying you had major medical problems and payed for them out of pocket?
> 
> 
> Why isn't it working for you now? It is a maximum fine of $975, if you can pay for major medical problem I wouldn't think that would sink you.
> ...


Never said I had a major medical problem did I? We had great insurance that was 1/3 of what were forced to pay now. We also lost around 8 emergency rooms.

So, your OK now that someone else is paying your bills? I always found away to pay for our own and not be a leach on others I don't even know. You know, personal responsibility!!


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## JeffreyD (Dec 27, 2006)

Nevada said:


> My Medicare HMO isn't a whole lot different from Obamacare HMO plans. In fact my Medicare HMO is underwritten by the same company that was underwriting my Obamacare HMO before I was 65.
> 
> HMOs aren't for everyone, but I save a fortune. I saw my doctor yesterday with zero copay. I like that.


Of course you like it when someone else pays YOUR bills for you.


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## Nevada (Sep 9, 2004)

JeffreyD said:


> Of course you like it when someone else pays YOUR bills for you.


Sure, everyone wants insurance that pays their bills. But there's a price to pay for having an HMO pay for your doctor visits; you have to assign a lot of the management of your healthcare to the insurance company. They can provide routine services inexpensively by denying advanced care when they can. If you're healthy it's a great deal, but if you have health issues they could deny care at a critical time.

If you don't have any major medical problems then a HMO might be your best solution. If you develop medical problems you have a safety valve; the open enrollment period. Just switch away from the HMO as soon as you realize you have a problem.


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## JeffreyD (Dec 27, 2006)

Nevada said:


> Sure, everyone wants insurance that pays their bills. But there's a price to pay for having an HMO pay for your doctor visits; you have to assign a lot of the management of your healthcare to the insurance company. They can provide routine services inexpensively by denying advanced care when they can. If you're healthy it's a great deal, but if you have health issues they could deny care at a critical time.
> 
> If you don't have any major medical problems then a HMO might be your best solution. If you develop medical problems you have a safety valve; the open enrollment period. Just switch away from the HMO as soon as you realize you have a problem.


That has nothing to do with my post, does it?


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## Bearfootfarm (Jul 13, 2006)

JeffreyD said:


> Of course you like it *when someone else pays* YOUR bills for you.


When one pays* into* the system for several decades, they are entitled to the benefits


----------



## Nevada (Sep 9, 2004)

JeffreyD said:


> That has nothing to do with my post, does it?


The insurance company pays for my doctor visits, not taxpayers. I was explaining why they offer such a sweet deal.


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## JeffreyD (Dec 27, 2006)

Bearfootfarm said:


> When one pays* into* the system for several decades, they are entitled to the benefits


Not above and beyond what was payed.


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## JeffreyD (Dec 27, 2006)

Nevada said:


> The insurance company pays for my doctor visits, not taxpayers. I was explaining why they offer such a sweet deal.


Aren't they subsidized by the government?


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## Nevada (Sep 9, 2004)

JeffreyD said:


> Aren't they subsidized by the government?


No. Medicare pays a premium to Medicare Advantage providers, but that's it. It's the responsibility of the insurance company to take care of the subscriber after that.


----------



## Nevada (Sep 9, 2004)

JeffreyD said:


> Not above and beyond what was payed.


We seem to have come full circle on this since the last administration. I remember when GWB was trying to promote privatizing Social Security and told us that nobody ever gets what they paid in to FICA back. That's simply not true.

In general, if you don't live to the average expected life expectancy (78-79) then you won't see your contribution back, indexed for inflation. You may see the exact dollar amount, but some of those are 40 to 30 year old dollars.

For people who live well into their 80s they'll see a lot more than they contributed. When people live well into their 90s they may see 3, or even 4, times what they paid in. The system supports getting a lot more back than was paid in for some people because they use funds not collected by people who died younger.

The same is true for Medicare. People who live into their 80s & 90s receive a lot more in care then they paid for.

The thing to keep in mind is that SS & Medicare have a built-in insurance component. There's nothing wrong with that.


----------



## JeffreyD (Dec 27, 2006)

Nevada said:


> We seem to have come full circle on this since the last administration. I remember when GWB was trying to promote privatizing Social Security and told us that nobody ever gets what they paid in to FICA back. That's simply not true.
> 
> In general, if you don't live to the average expected life expectancy (78-79) then you won't see your contribution back, indexed for inflation. You may see the exact dollar amount, but some of those are 40 to 30 year old dollars.
> 
> ...


There is if your receiving benefits above what you paid in. It cannot be sustained much longer, then what will you do?


----------



## JeffreyD (Dec 27, 2006)

Nevada said:


> No. Medicare pays a premium to Medicare Advantage providers, but that's it. It's the responsibility of the insurance company to take care of the subscriber after that.


So why are the providers crying about getting reimbursed far below what their costs are? My state says they need extra billions from the Fed, why is that?


----------



## Nevada (Sep 9, 2004)

JeffreyD said:


> There is if your receiving benefits above what you paid in. It cannot be sustained much longer, then what will you do?


As I said, the system works because we get to use FICA funds paid-in by people who died younger. It's a lot of money. FICA receives funds from some people at 15% of their pay during their entire career, then die at 60 years old, never receiving a penny back. People who live longer get that money.


----------



## Nevada (Sep 9, 2004)

JeffreyD said:


> So why are the providers crying about getting reimbursed far below what their costs are? My state says they need extra billions from the Fed, why is that?


I have no idea what that's about. I'm covered by a private insurance company.


----------



## Bearfootfarm (Jul 13, 2006)

JeffreyD said:


> Not above and beyond what was payed.


I suspect you have no idea of the actual numbers involved.
If by some chance you do, please show them


----------



## Farmerga (May 6, 2010)

Nevada said:


> We seem to have come full circle on this since the last administration. I remember when GWB was trying to promote privatizing Social Security and told us that nobody ever gets what they paid in to FICA back. That's simply not true.
> 
> In general, if you don't live to the average expected life expectancy (78-79) then you won't see your contribution back, indexed for inflation. You may see the exact dollar amount, but some of those are 40 to 30 year old dollars.
> 
> ...


Other than the fact that it is not voluntary and the Federal Government is doing it, you are correct.


----------



## Nevada (Sep 9, 2004)

Farmerga said:


> Other than the fact that it is not voluntary and the Federal Government is doing it, you are correct.


If the government has an interest in keeping citizens out of desperate poverty, then the government has an interest in citizens amassing retirement benefits.

I can remember wondering if SS was going to exist when I retired, and I can remember resenting the payroll deduction. But now that I'm 65 I'm happy it was done.


----------



## Farmerga (May 6, 2010)

Nevada said:


> If the government has an interest in keeping citizens out of desperate poverty, then the government has an interest in citizens amassing retirement benefits.
> 
> I can remember wondering if SS was going to exist when I retired, and I can remember resenting the payroll deduction. But now that I'm 65 I'm happy it was done.


The Federal Government hasn't the authority for this program. If your idea of what it takes to allow the Feds to do something were true, there would be NOTHING that they couldn't touch. They could claim an interest in what I had for breakfast and regulate it. (more than they already do). 

You may want government to take care of you, and thereby, enslave you, but, many of us do not.


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## Jim Bunton (Mar 16, 2004)

Do you feel the government has the authority to criminalize heroin and other drugs.

Jim


----------



## watcher (Sep 4, 2006)

Nevada said:


> Letting Americans die for lack of medical treatment is an undesirable outcome. I think we can do better.


If you think so then why are you not working within the constitution to change it? How much of your time and money have you spent on forming a private community medical center? 

Why do you think you have the right to use force, either directly yourself or indirectly via the government, to make others who do not think the way you do to follow your belief?


----------



## watcher (Sep 4, 2006)

Nevada said:


> I doubt that's possible. The alternative to government administrated insurance is charity, but there just aren't enough charitable resources available. I don't think there ever can be enough charitable resources to do the job. As I pointed out before, it's not unusual for a family to pay $1,000/month for health insurance, but a $1,000/month charitable contribution would be extraordinarily large. You can't expect charity to accomplish what insurance accomplishes.


Its not an either or situation. Just because you don't have a government thug with a gun forcing you to buy insurance you don't automatically have to rely on someone else to cover your medical cost.

You could let the individual's make their own choices and live with the results. If you wish to have 1st rate medical care you buy insurance to cover it. If you want to roll the dice you can skip insurance or if you can't afford insurance or care then you must rely on the good will of others.


----------



## watcher (Sep 4, 2006)

Nevada said:


> Medical procedures are expensive to the point where they just aren't possible without insurance. Without insurance the demand for expensive lifesaving procedures would evaporate for the most part, and businesses that offered those procedures would cease to exist. That would be bad for the economy, bad for the medical industry, and bad for the American people.


Yeah, insurance and government interference has really been a boon for corrective eye surgery and its technology.


----------



## watcher (Sep 4, 2006)

Jim Bunton said:


> Unless you are wealthy it only worked well for you as long as you didn't have any major medical problems or the government forced hospitals to treat emergency patients and then subsidized hospitals for doing it. Then hospitals over charged patients who could pay or had insurance to make up the difference. That is how the old system worked.
> 
> Jim


Wow, I didn't know I was wealthy! Thanks for letting me know that just because I worked hard and provided health care insurance for my family I am now one of the wealthy.

I have never been w/o insurance. In my early adult hood (before I had kids) I had catastrophic coverage because I was young and fit and was willing to pay for any doctor visits out of pocket. After I had kids I switched to a 'full coverage' plan because kids tend to have a lot of medical issues. I kept the 'full coverage' after the kids were out of the house because old. . .ah older people tend to have a lot of medical issues as well. We have been very blessed because neither the wife nor I have any major chronic medical issues.


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## watcher (Sep 4, 2006)

Nevada said:


> If the government has an interest in keeping citizens out of desperate poverty, then the government has an interest in citizens amassing retirement benefits.
> 
> I can remember wondering if SS was going to exist when I retired, and I can remember resenting the payroll deduction. But now that I'm 65 I'm happy it was done.


 Its NOT the government's job to take care of the individual. Its NOT the government's job to be your nanny and make sure you eat your veggies, take your vitamins and put away money for a rainy day.


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## arabian knight (Dec 19, 2005)

Shoot I had insurance for years myself as well. As I was going to a Orthopedic Surgeon for my ankles and knees WAY back in the mid 70's, x-rays, cortisone shots way back then. And I sure didn't have that kind of cash to pay for the deal. 
My insurance even back then paid for Chiropractic adjustments.
And yes that same Dr. that was treating me for my bad ankles and knees and such back in the 70's, was ALSO the same Dr. that did my total knee replacement 5 years ago. That is how long I have been going to that particular Dr.
In fact he just retired last year so now when I get my other knee replaced, I will have to have another Dr. do it. Which is too bad cause I really like him.
In fact I do believe that is why my SS Disability was approved so quickly, as I had YEARS of records and x-ryas and such from that one Doctor that had been treating me all those years.


----------



## watcher (Sep 4, 2006)

Jim Bunton said:


> Do you feel the government has the authority to criminalize heroin and other drugs.
> 
> Jim


I don't think it has the power to ban it outright but it does have the authority to make sure they are safe and effective. 

If a drug company were to go through the FDA certification process and get it approved a prescription for heroin should be as easy to get as one for any other narcotic.


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## Farmerga (May 6, 2010)

Jim Bunton said:


> Do you feel the government has the authority to criminalize heroin and other drugs.
> 
> Jim


They have the authority to outlaw them from crossing state lines/international boarders, but, within states, they have not. I don't believe that they should, but, they do have limited authority in that area, yes.


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## Laura Zone 5 (Jan 13, 2010)

I think those who deal, peddle, sell heroin; Those who supply the dealer's w/ heroin, should face the death penalty; in public, immediately.

I am 100% AGAINST the death penalty, so for me to say this, it's not said lightly.

Heroin is turning America into an episode of The Walking Dead.

Junkies need to be collected, and mandatory rehab for a MINIMUM of 1 year, and the dealers, peddlers, suppliers, should be executed in public.


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## Farmerga (May 6, 2010)

Laura Zone 5 said:


> I think those who deal, peddle, sell heroin; Those who supply the dealer's w/ heroin, should face the death penalty; in public, immediately.
> 
> I am 100% AGAINST the death penalty, so for me to say this, it's not said lightly.
> 
> ...


Then the proper course of action would be to lobby your State representative to enact legislation, for your state, to deal with drug dealers/users as you see fit.


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## watcher (Sep 4, 2006)

Laura Zone 5 said:


> I think those who deal, peddle, sell heroin; Those who supply the dealer's w/ heroin, should face the death penalty; in public, immediately.
> 
> I am 100% AGAINST the death penalty, so for me to say this, it's not said lightly.
> 
> ...


I disagree. If you or your neighbor wants to drink a liter of vodka a day or shoot up heroin he should have that right. As long as he dies it in his own home and poses no threat to others. Its not up to you to determine what's 'right' for him in this area than it is for someone to determine what's 'right' for you when it comes to medical care/insurance. 

Now if the user does anything which endangers others then you throw the book at him. IMO, anyone caught driving drunk should be charged with some equivalent to attempted murder.


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## Laura Zone 5 (Jan 13, 2010)

Laura Zone 5 said:


> I think those who deal, peddle, sell heroin; Those who supply the dealer's w/ heroin, should face the death penalty; in public, immediately.
> 
> I am 100% AGAINST the death penalty, so for me to say this, it's not said lightly.
> 
> ...





watcher said:


> I disagree. If you or your neighbor wants to drink a liter of vodka a day or shoot up heroin he should have that right. As long as he dies it in his own home and poses no threat to others. Its not up to you to determine what's 'right' for him in this area than it is for someone to determine what's 'right' for you when it comes to medical care/insurance.
> 
> Now if the user does anything which endangers others then you throw the book at him. IMO, anyone caught driving drunk should be charged with some equivalent to attempted murder.


You do realize that the epidemic of CHILDREN addicted to Heroin (that means humans aged 10-17 and 364 days).
DEALERS selling White China for them to smoke/snort, then when they get 'hooked' tell them that they have to shoot the Black Tar and THEN they will sell them the White China..........too late............NOW they are hooked on the Black Tar, and coming to the dealer, daily.

Here in Indiana, the epidemic of Heroin Junkies is so bad, they are selling Narcan over the counter???? Is an antidote for heroin overdose. 

Instead of 'free needles' how about "free rehab".
How about putting junkies in rehab, and executing the dealers.
When the junkies come out clean........there will be no dealers to try and get them hooked again.

Heroin is turning America into an episode of The Walking Dead.
It is destroying families, lives, children, etc.......
You publicly execute enough dealers; they will think twice about peddling that junk.


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## watcher (Sep 4, 2006)

Laura Zone 5 said:


> You do realize that the epidemic of CHILDREN addicted to Heroin (that means humans aged 10-17 and 364 days).
> DEALERS selling White China for them to smoke/snort, then when they get 'hooked' tell them that they have to shoot the Black Tar and THEN they will sell them the White China..........too late............NOW they are hooked on the Black Tar, and coming to the dealer, daily.
> 
> Here in Indiana, the epidemic of Heroin Junkies is so bad, they are selling Narcan over the counter???? Is an antidote for heroin overdose.
> ...


You can't support freedom and demand the government have the ability to control what adult individuals do in their personal lives. 

You don't want people using heroin and want the government to enforce your desire. What about someone who doesn't want people to use alcohol? What about someone who doesn't want people to eat meat? Should the government use the threat of violence to force their beliefs on you?

A couple of the most difficult things about freedom is having to put up with things you don't agree with and realizing when you give people freedom some of them are going to do things which are not good for themselves and/or society in general.


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## Laura Zone 5 (Jan 13, 2010)

watcher said:


> You can't support freedom and demand the government have the ability to control what adult individuals do in their personal lives.
> 
> You don't want people using heroin and want the government to enforce your desire. What about someone who doesn't want people to use alcohol? What about someone who doesn't want people to eat meat? Should the government use the threat of violence to force their beliefs on you?
> 
> A couple of the most difficult things about freedom is having to put up with things you don't agree with and realizing when you give people freedom some of them are going to do things which are not good for themselves and/or society in general.


Then I am 100% down for vigilante behavior.
You clearly have no idea what heroin is doing to our country, our future generations; our future as a country. 
It is like a plague; like a swarm of locust.


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## Nevada (Sep 9, 2004)

Laura Zone 5 said:


> Then I am 100% down for vigilante behavior.
> You clearly have no idea what heroin is doing to our country, our future generations; our future as a country.
> It is like a plague; like a swarm of locust.


The war on drugs does its own damage too. I'm not sure it's worth it.


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## Bearfootfarm (Jul 13, 2006)

Laura Zone 5 said:


> I think those who deal, peddle, sell heroin; Those who supply the dealer's w/ heroin, should face *the death penalty; in public*, immediately.
> 
> I am 100% AGAINST the death penalty, so for me to say this, it's not said lightly.
> 
> ...


That sounds a lot like Sharia Law.
Hitler also liked those same tactics


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## watcher (Sep 4, 2006)

Laura Zone 5 said:


> Then I am 100% down for vigilante behavior.
> You clearly have no idea what heroin is doing to our country, our future generations; our future as a country.
> It is like a plague; like a swarm of locust.


Sounds a lot like what people were saying about the evils of alcohol when they were pushing for prohibition.

Let me ask you this, how would you like it if the government banned the use and sale of meat because of the damage it is doing to the health of Americans?

Don't you think YOU should have the freedom to choose what you do or not do as long as the action does not effect another?


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## Farmerga (May 6, 2010)

Nevada said:


> The war on drugs does its own damage too. I'm not sure it's worth it.


True. A few counties over, we had the sheriff's department conduct a "No knock" raid and threw a flash grenade into a sleeping baby's crib and do much damage to the child. The rub was that there were no drugs in the house as the informant was mistaken/lied.


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## itsb (Jan 13, 2013)

watcher said:


> Sounds a lot like what people were saying about the evils of alcohol when they were pushing for prohibition.
> 
> Let me ask you this, how would you like it if the government banned the use and sale of meat because of the damage it is doing to the health of Americans?
> 
> Don't you think YOU should have the freedom to choose what you do or not do as long as the action does not effect another?


WOW! how can you even attempt to compare the sale of hreion to the sale of meat !! I would much rather my kids to be hooked on beef jerky as to herion!!
Lara5 I get what you are sayin and agree with ya. Ive been trying to figure out why it takes a dr. prescription to get an epie-pen but you can get a herion pen over the counter or for free !! I guess its the same as herion vs meat :bash:


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## Nevada (Sep 9, 2004)

Farmerga said:


> True. A few counties over, we had the sheriff's department conduct a "No knock" raid and threw a flash grenade into a sleeping baby's crib and do much damage to the child. The rub was that there were no drugs in the house as the informant was mistaken/lied.


Mistakes like that are unfortunate, but that's not the problem with the war on drugs.


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## Farmerga (May 6, 2010)

Nevada said:


> Mistakes like that are unfortunate, but that's not the problem with the war on drugs.


 Well, yeah, it is too expensive, too authoritarian, largely unconstitutional, ineffective, etc.


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## watcher (Sep 4, 2006)

itsb said:


> WOW! how can you even attempt to compare the sale of hreion to the sale of meat !! I would much rather my kids to be hooked on beef jerky as to herion!!
> Lara5 I get what you are sayin and agree with ya. Ive been trying to figure out why it takes a dr. prescription to get an epie-pen but you can get a herion pen over the counter or for free !! I guess its the same as herion vs meat :bash:


FREEDOM. Do you know what that means? It means I don't get to have the government stick a gun in your face and tell you to stop doing something because I don't like it.

This applies to eating meat or using heroin. Unless and until why you do interferes with the rights of another you should have the freedom to do it.

Once you start imposing your view of what's "right" and what's "wrong" you have just given others the same power. All they need is a majority to vote the right people in office and their view will become law and if the elected officials have anointed the right number of people in the proper places it will also be declared constitutional.


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