Medicare for all — net costs

[yeahman]

the MD's and dentists i know all seem to be doing pretty good

Interesting article here about how much they make. It actually seems surprisingly murky. But the tl;dr version is that the average Canadian doctor probably nets (after office expenses and taxes) about $130,000 CAN. That's how I read it anyway. There is a range, of course.

https://www.theglobeandmail.com/life...rticle7750697/

[XXX-er]

Duno how it is down there but like the article sez up here they pretty much all incorporate, I'm reading that a lot of the new MD's don't get an office, just locum and some specialties don't need offices or staff

[BCMtnHound]

I think the FN somehow get free dental BCH

Yup, but that is specified under the federal Indian Act, and associated Indian Health Policy. I am not intimate with any linkage between the Canada Health Act and the Indian Act, but basic health care is covered under the provincial/territory insurance, and the other stuff falls under the Non-Insured Health Benefits program, paid for by the feds.

[iceman]

That's so assbackwards. A lot of serious health problems can be avoided through regular basic dental care.

True, but it's not quite as assbackwards as no healthcare at all.

What I wonder is, is there any incentive for a Canadian doctor to work harder, learn more stuff, etc. than another doctor? I know our system sucks but at least in general the smart guys get rewarded with better jobs and more money and it's theoretically possible to identify them through that.

[4matic]

Dental insurance is expensive for what you get. Basically a net $1k-$1.5k benefit. I’d trade that for universal care every day.

[BCMtnHound]

What I wonder is, is there any incentive for a Canadian doctor to work harder, learn more stuff, etc. than another doctor? I know our system sucks but at least in general the smart guys get rewarded with better jobs and more money and it's theoretically possible to identify them through that.

My personal observation is that geography plays a bit part. Family docs have the highest overhead, specialists in the hospital have the lowest. Hospitals, especially the advanced trauma care facilities, are few and far between compared to countries/regions with more evenly distributed populations. So most physicians are trying to get to the centres where the major hospitals (and universities with medical programs) are. Real shortage of family physicians in the rural towns over most of the country, and british or s.african accents are very common in those rural clinics.

[yeahman]

So in Canada, if you need an ACL repair, do you get to choose what doctor you want to do the surgery, or do you get assigned to somebody?

[BCMtnHound]

So in Canada, if you need an ACL repair, do you get to choose what doctor you want to do the surgery, or do you get assigned to somebody?

My understanding is yes. All specialist referrals need to go through your primary physician, and in consultation with them you can request a specific specialist. That said, popular specialists will likely have significant wait times for treatment. Some provinces are trying out a centralized or pooled referral system, but I don’t know what that effect has been on wait times.

[evdog]

When I tore mine, I went to a family doctor to get a referral to a surgeon. It works somewhat like an HMO in that respect. I didn't know who would be a good surgeon anyways and yelp didn't exist back then. The surgeon this doctor wanted me to see had a 9-10mo waitlist just for an initial appointment. Turned out that's because he is one of the best and most sought after and is still the Canucks team surgeon. Maybe the wait time would have been less for someone who wasn't so highly recommended. For me it was worth the wait. Once I had the initial exam I had my choice of any surgery date starting about 2 weeks out. Incidentally my total cost for that surgery was having to pay $8 for a copay for percocet prescription and $25 for crutches. Hard goods like crutches or knee brace aren't covered by Canada health plan.

I tore my ACL earlier this year and got a full comparison under US health system. Wait time was just a few weeks to see a surgeon, no referral required. Picked the earliest possible surgery time which was a few weeks later. Total out of pocket on my insurance plan is $4k, and that is what I've paid. The big difference aside from the wait time has been getting a copy of every bill from every provider. It has totalled $59k so far. The insurance company, bless their hearts, has negotiated rates that brought that cost down to about $13k in actual cost. Any mistake on behalf of insurance or provider seems to be my responsibility to sort out as both sides have ranged from unhelpful to completely incompetent.

The whole in-network vs out-of-network discrepancy is pretty asinine. It makes no sense to bill someone who has no health insurance such a ridiculous amount. Wouldn't it be easier to negotiate rates that are the same across all networks and they you could go to any provider you choose? And they would be more affordable for everyone, so maybe they'd collect more of it. It just seems like its all geared to make things as opaque as possible so they can make more money due to lack of transparency. What other industry gets away with providing critical services without you having any opportunity to do price comparisons and find out what it will actually cost?

I can't help but think that significant improvements could have been made to the health care system here without Obamacare, just by putting in some simple rules to improve transparency and behavior among providers. But on the other hand the cost we probably need mandatory minimum insurance coverage in order to bring costs under control. Without it, too many people forego insurance because they are "healthy", when in reality they are just a bad car crash or cancer diagnosis away from massive medical bills that will now get passed on to everyone else through higher costs. Including the rich people who complain that under public health insurance they'd have to subsidize health care for the poor. Well guess what... you already are.

[yeahman]

Interesting. But what if it's not an ACL, what if it's a brain tumor? Can't wait ten months for brain surgery. My brother had a tumor and my mom, who at the time was a nurse at the University of Minnesota hospital, found the absolute best surgeon practically in the world to do the operation, and it was done almost immediately. I'm guessing in Canada you would be in a tough spot if you needed brain surgery and the best surgeons were booked solid. To this day the doctors say my brother is the highest functioning post-cranial they've ever seen. My mom's efforts, and her insider knowledge of the surgical staff at the University at that time, surely had a lot to do with that.

Anyway, just asking these questions because I'm curious what Americans would be sacrificing by switching to a Canada-like national health care system.

[iceman]

One thing I've heard about, but don't know how true it currently is or how much it really affects things, is a relative scarcity of high-tech machinery in Canada. About 7-8 or so years ago I was talking to a Doctor about this same general topic, and he claimed that there were more MRI machines in Greater Boston than there were in Canada.

He said it was because there's financial motivation for US hospitals to get the equipment and that that they don't have that motivation in Canada, in fact kind of the opposite. He wasn't claiming that Canadian doctors are bad and was emphatic on that, or that the standard of care was bad, just that resources are scarcer in that system and that affects the way things are diagnosed and treated.

Seems reasonable, but I still wish we had that system regardless.

[dunfree]

holy shit, you'd just go to another country. like all kinds of US people are doing because they couldn't afford shit in the US, or they didn't have all kinds of awesome connections to get the absolute best care in the US for dirt fucking cheap (which 95%+ of the US doesn't have).

well, except the US people who just go without and end up dead, or just leaches in one way or another.

Goddamn this fear mongering is fucking retarded. We - the US - can't continue to pay the escalating cost of healthcare in % GDP. We can't, no matter what fucking label you put on it. It'll eat the US alive. So we need to fix it somehow - align market forces to allow individuals to make informed choices, or socialize the costs somehow. Or something else. But it's not fucking sustainable as is. Doing the same is a choice and a fatal one.

[iceman]

If you're talking about my post I think it was pretty even-handed.

[dunfree]

If you're talking about my post I think it was pretty even-handed.

there've been all kind of money incentives for people to invest in machines that don't improve care:
https://www.healthaffairs.org/doi/fu...haff.2009.1099
that's a paper from memory, if it's wrong, please someone correct me.

the point - that our healthcare spending - public or private - isn't sustainable stands.

[yeahman]

there've been all kind of money incentives for people to invest in machines that don't improve care:
https://www.healthaffairs.org/doi/fu...haff.2009.1099
that's a paper from memory, if it's wrong, please someone correct me.

the point - that our healthcare spending - public or private - isn't sustainable stands.

I don't see anybody fear mongering. People have a right to ask legitimate questions about socialized medicine.

[rod9301]

holy shit, you'd just go to another country. like all kinds of US people are doing because they couldn't afford shit in the US, or they didn't have all kinds of awesome connections to get the absolute best care in the US for dirt fucking cheap (which 95%+ of the US doesn't have).

well, except the US people who just go without and end up dead, or just leaches in one way or another.

Goddamn this fear mongering is fucking retarded. We - the US - can't continue to pay the escalating cost of healthcare in % GDP. We can't, no matter what fucking label you put on it. It'll eat the US alive. So we need to fix it somehow - align market forces to allow individuals to make informed choices, or socialize the costs somehow. Or something else. But it's not fucking sustainable as is. Doing the same is a choice and a fatal one.

Yes

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[Self Jupiter]

[bodywhomper]

I tore my ACL earlier this year and got a full comparison under US health system. Wait time was just a few weeks to see a surgeon, no referral required. Picked the earliest possible surgery time which was a few weeks later. Total out of pocket on my insurance plan is $4k, and that is what I've paid. The big difference aside from the wait time has been getting a copy of every bill from every provider. It has totalled $59k so far. The insurance company, bless their hearts, has negotiated rates that brought that cost down to about $13k in actual cost. Any mistake on behalf of insurance or provider seems to be my responsibility to sort out as both sides have ranged from unhelpful to completely incompetent.

Does the $4k include annual premium, meds, drugs, PT, initial and follow-up visits, etc?

[Mazderati]

Or hours looking over EOBs and talking on the phone with insurers and providers. Or fees for equipment or services not covered by insurance.

[Supermoon]

Sample size of one, but when I was working for a ski company, one of our athletes (insert famous Canadian skier here) needed a knee procedure, and he told them his knees were important for his work and they got him into the best knee guy in Canada in a couple of weeks. Seems like people wait longer for things that aren’t urgent in Canada, but when you need it fast they get you in.

My BIL needed back surgery that was a workers comp claim, and it was going to take so long he finally told the doc he did it at the gym and paid for it himself. ‘Merica.

[iceman]

[Tri-Ungulate]

True, but it's not quite as assbackwards as no healthcare at all.

What I wonder is, is there any incentive for a Canadian doctor to work harder, learn more stuff, etc. than another doctor? I know our system sucks but at least in general the smart guys get rewarded with better jobs and more money and it's theoretically possible to identify them through that.

Uh, I suppose 'cuz they wanna do right by the people they're taking care of?

Believe me, "better jobs and more money" does NOT necessarily correlate with better clinical skills, whether it be by working harder or leaning more "stuff".

[dunfree]

I don't see anybody fear mongering. People have a right to ask legitimate questions about socialized medicine.

the answers the same for you in both systems. If you've enough money you can get treatment when you want it. One question is who's paying the money - in "socialized" medicine you - in our not-quite capitalist system you, via employer benefits or "insurance". the other question is what's the cost threshold for delivery.

[Kenny Satch]

Said it before and I'll say it again.
Universal health care does Not financially destroy lives. It's not perfect but having to deal with a $500,000 bill might kill you before any illness does. Imagine that you're really sick and have no insurance but you need the opperation(s) and treatments so all your savings or equity in your home is gone because you want to live. Seems barbaric not to be protected from that.

Don't knock universal health care until you try it.

[iceman]

I don't think anyone was knocking it and as I said before I wish it was our system. But to suggest that it's possible that some things may be better dealt with in the US system hardly seems heretical to me. Maybe cost is the only metric that matters in the end