Medicare for all — net costs

[Tri-Ungulate]

Interesting. But what if it's not an ACL, what if it's a brain tumor?

It's my understanding that cases are triaged based on urgency. So yeah, if a brain tumor, ideally expedited evaluation. Canuckistanian healthcare dentists can confirm or deny.

[Tri-Ungulate]

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

Nah, I didn't think you were knocking it. I was just sayin' that purely monetary incentives do not necessarily equate with better or more comprehensive healthcare from the practitioner's perspective. IMO and in my limited experience, that is.

[XXX-er]

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. .

well Canada is only about the size of California population wise but its huge in terms of land mass so you don't have an MRI machine in every hospitol

but ask yerself if Boston really needs all those MRI machines/personel/ yada, and who is paying for it all with money that is perhaps better spent elsewhere because if we look at life expectancy more money does not mean people live longer and the USA is still neck and neck with Cuba

[XXX-er]

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.

My father had a quite a few medical issues like stroke/ brain surgery/heart attack but it was all taken care of woith no bills, it might have been the brain surgery where upon a visit to the GP they called an ambulance and my father went pretty much straight from the doc's office to the OR

The MD it is assumed is pretty smart and has been to like grade 27 or sft so he makes the decisions not an insurance company ... cuz there is no insurance company



but Geriatric medicine is different in Canada ... we just put them out on an iceflow

[yeahman]

but Geriatric medicine is different in Canada ... we just put them out on an iceflow

Heh. But I am curious, what about longterm care for the elderly in Canada? Dementia/Alzheimers patients etc. Are the costs for longterm care all covered for all citizens regardless of their ability to pay or not pay?

[pow_pow~]

So in Canada, is there a private health care industry in addition to the one that serves the public? Meaning can somebody who is rich hire a doctor who works outside the public health system for rich cash-paying clients, maybe get seen sooner, or not have to wait for surgery or whatever (as I've heard is sometimes an issue)? Or are there laws to prevent doctors from working outside the public system like that?

that is exactly how it works in australia.

[pow_pow~]

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.

If its life threatening it gets done immediately and the non-life threatening gets pushed back. Brain surgeons don't usually have wait times as everything is life threatening in their line of work so no need to book for anything.

thats how it is in Aus which is pretty much the same as Canada.

[pow_pow~]

Heh. But I am curious, what about longterm care for the elderly in Canada? Dementia/Alzheimers patients etc. Are the costs for longterm care all covered for all citizens regardless of their ability to pay or not pay?

of course costs are covered. however if you have private insurance you could probably go to a nicer facility (Aus- sorry for triple post)

[Mazderati]

I was just sayin' that purely monetary incentives do not necessarily equate with better or more comprehensive healthcare from the practitioner's perspective.

Or the patient's. How about one physician performing 41 surgeries over two days. No way is that level of care where it should be.

[BCMtnHound]

Heh. But I am curious, what about longterm care for the elderly in Canada? Dementia/Alzheimers patients etc. Are the costs for longterm care all covered for all citizens regardless of their ability to pay or not pay?

My wife is a nurse in public long-term care. There is a waiting list for placement in her facility, and they come from as far as a few hours drive away. She has worked in the private palliative system, and both have similar challenges with respect to service delivery and care resourcing. But the private care does have larger, more modern buildings with flashier gardens and font common areas. Public palliative care is covered under the same fed/prov insurance regime. With current demographic trends, there are significant funding and staffing challenges, but that is not unique to Canada or its health care system.

[yeahman]

^^Thanks, I appreciate the info BCMountainHound and XXX-er.

[evdog]

Seems like people wait longer for things that aren’t urgent in Canada, but when you need it fast they get you in.

That's pretty much it. If you show up at the ER broken or bleeding you'll be seen pretty quick. I went to the ER when I broke my hand, and they had me booked in for surgery at 630am the next morning. Got bumped to the afternoon because a more serious case came in. When I broke my wrist at Whistler the clinic got me a referral to a specialist in Van 2 days later. We scheduled surgery 2 days after that. Stuff like torn ACL or hip replacement aren't urgent and tend to have wait times to see a specialist initially. Sometimes after that there is another wait for surgery, sometimes you can pretty much pick your date. It can depend a lot on where you live too. Rural areas have fewer doctors and specialists so you wait longer. My mom waited 18mos to see someone for her knees. The wait would have been much less if she'd been willing to travel to Vancouver.

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.

For things like MRI there will be waits too and it is definitely the result of there being fewer machines. The flipside is they are highly utilized which is a good thing cost-wise, but I'd bet most people would say spending some $ to bring in more machines would be money well spent. The link below says recent wait times in Canada for an MRI have been 11 weeks on average, or much longer in BC. Down here I had an MRI two days after the initial visit with my surgeon. Had a choice of many time slots over the course of the next week. With that many open slots and five other machines within a 15 min drive from my work, those things can't be getting used very efficiently so it's not surprising they charge a lot to help cover their costs. They must make money though or there wouldn't be so many of them. In Canada it is more a political decision - how much of the budget goes to healthcare, then hospitals have to allocate funds according to needs. If people really wanted to hold the gov'ts feet to the fire there would probably be more machines available. But on the other hand taxes would go up. We all know how much people love taxes.

2017 wait time report from the Fraser Institute: https://www.fraserinstitute.org/site...-turn-2017.pdf

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

The premium is on top of it. I have a high deductible HSA plan this year so my share of the premium is $20 per paycheck. Employer pays the rest, not sure how much. They also contributed $750 in free money to my HSA to start with, and I can contribute another $2700 in pre-tax funds this year. So that might be worth $1k itself. The $4k is my out of pocket cost including deductibles and copays for all the other items mentioned. I rented some equipment to keep my knee in motion right after surgery, and that was not covered by my insurance so I had to pay it out of pocket ($300) but was well worth it. Knee braces and everything else were covered. Insurance limited me to 16 PT appointments but they were all covered. I had the same limitation on PT in Canada. I won't have out of pocket expenses for any more follow up visits or any other treatments this year since I've hit the maximum, unless I go out of network. Need to check what other work I need done...

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.

Very true. It is far from perfect but I'd take it over the US system in a heartbeat. Sometimes you have to wait, but there is so much less drama and you can focus on getting better rather than battling it out with providers and insurance co over bills. I can't imagine the stress people go through who have chronic conditions or long hospital stays or have poor insurance plans. I handled HR and benefits at my last company and even though we had one of the best plans available I still heard no end of stories from staff. One guy was approved for surgery by insurance co, had the surgery, and then they retroactively decided it wasn't approved after all. Then he had providers coming after him for the full bill, not the insurance co discounted deal. Another guy's wife had a baby and after some paperwork went missing the insurance co was refusing to add the baby to the plan for a while. A third guy was stuck because the insurance co sent a payment to the provider, but not their current billing address. They cashed the check of course, but didn't credit it to his account. Insurance wouldn't help because they had paid it, and provider was adamant they hadn't been paid, and sent it to collections. I could go on all day. Most were settled ok in the end but only with a lot of effort and frustration on the part of the patient. This is the kind of shit you don't have to deal with in Canada.

[XXX-er]

Heh. But I am curious, what about longterm care for the elderly in Canada? Dementia/Alzheimers patients etc. Are the costs for longterm care all covered for all citizens regardless of their ability to pay or not pay?

IME what happened is they take whatever yearly income the patient shows to pay for the long term care and the system makes up the rest so the Fam is not hit with a big bill, mom payed more for the home cuz she made too much money from investments, we always told mom she was showing too much income and at he age of 90 she should give it all away and show NO income but even if she could hear... she didn't listen

[Sirshredalot]

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.

FWIW, the people who do healthcare economics point to the MRI spending as an example of waste. We have way the fuck more MRI machines per capita than say, Canada, Japan, or Singapore, and we are definitely paying a shit-ton for them. But it's not like people in Japan are all hobbling around on undiagnosable soft tissue injuries: they're healthier than we are!

[The Tortoise]

I had the pleasure of interacting with both systems following a crash at mach looney that sent me into a snowmaking tower. Fuck that sucked.

I had excellent care in Vermont. A CT and Surgery within an hour of arriving at the hospital and an MRI two days after. Thank god I had travel insurance, I didn't pay a cent.

I was transferred to Ottawa 5 days after the crash and where I spent 3 weeks and had another surgery. Total bill for the 3 weeks in the hospital that included surgery and a CT and treatment for pulminary embolisms: $0. I had routine care at home, including rental of hospital beds, INR testing and in home physio. That was also covered.

My impression is that the quality of medical care between Vermont and Ottawa were easily comparable. The quality of service however, Vermont was way better. The nursing staff seemed to have way more time to care for the patient, the food was so much better and it was a private room with "free television". In Ottawa you pay per day for TV, the food fucking sucks and the nursing staff, while fantastic, seemed to be busier. I would imagine that in Canada you need to be a stronger advocate for your own care because of this, but that is just speculation.

I was able to get physio coverage for 8 months as part of my rehab. In retrospect I should have sought more PT but I was dealing with a lot at the time.

[Peruvian]

You can pay for a lot of TV and Sysco meals for $2 Trillion.

[iceman]

Probably still can't get HBO though.

[bagtagley]

All those MRI machines are using up the helium I'd otherwise be using for my balloon habit.

[dunfree]

My wife is a nurse in public long-term care. There is a waiting list for placement in her facility, and they come from as far as a few hours drive away. She has worked in the private palliative system, and both have similar challenges with respect to service delivery and care resourcing. But the private care does have larger, more modern buildings with flashier gardens and font common areas. Public palliative care is covered under the same fed/prov insurance regime. With current demographic trends, there are significant funding and staffing challenges, but that is not unique to Canada or its health care system.

In the US for senior care you'll end up on a waitlist at most facilitys because empty beds don't make money. If you are reliant on significant state support for paying for your facility the number of facilitys that will take you is smaller and the waitlist possibly longer. Recent family experience. Note though that the generosity of the US state the facility is in and how it chooses to administer programs can effect these things as well.

[BCMtnHound]

In the US for senior care you'll end up on a waitlist at most facilitys because empty beds don't make money. If you are reliant on significant state support for paying for your facility the number of facilitys that will take you is smaller and the waitlist possibly longer. Recent family experience. Note though that the generosity of the US state the facility is in and how it chooses to administer programs can effect these things as well.

Palliative care is the easiest to define for the system, determining that one is no longer able to perform the basic personal care functions is relatively easy for our system to address. It is the lead into end of life care that is the more difficult part. Being able to manage your own care to some level will place the burden of your housing and support on you (or your spouse/family). We are fortunate that both my wife and parents are reasonably well off and will have options for senior community living, assisted living, and the like as they approach the possible need for palliative care. Many do not, and their options are far more limited. But that is maybe beyond the scope of this conversation.

[AdironRider]

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.

I would gladly pay $3967 extra dollars to not give up the better part of a year of my life waiting to get an ACL fixed. Combine that with Iceman's comments on the lack of motivation to innovate, upgrade equipment etc and you know exactly why universal isn't coming to the USA.

[Supermoon]

I would gladly pay $3967 extra dollars to not give up the better part of a year of my life waiting to get an ACL fixed. Combine that with Iceman's comments on the lack of motivation to innovate, upgrade equipment etc and you know exactly why universal isn't coming to the USA.

I think you are reading that wrong. Total cost billed was at least $13k. It's not like the insurance company is just paying the extra $9k out of the goodness of their hearts, you pay that, plus their profit margin. Just not all at once.

[AdironRider]

His out of pocket was 4k. The rest was hospitals and insurance doing their dance no?

It comes down to out of pocket costs for pretty much everybody. I'm sure there are folks who would balk at paying 3967 for 9 months of physical activity, but I doubt it is the majority. No one really gives a shit if the hospital marks it up so they can mark it down.

[Supermoon]

His out of pocket was 4k. The rest was hospitals and insurance doing their dance no?

It comes down to out of pocket costs for pretty much everybody. I'm sure there are folks who would balk at paying 3967 for 9 months of physical activity, but I doubt it is the majority. No one really gives a shit if the hospital marks it up so they can mark it down.

How I read it was 56->13k was the dance. Insurance covered 9k and he paid 4. But that 9k isn’t just free money. That cost and more gets passed on to you by the insurance company through premiums and other fees. So the true cost is at least the 13k that was finally billed.

[Dantheman]

His out of pocket was 4k. The rest was hospitals and insurance doing their dance no?

That $4k doesn't include his premiums.

I'm sure there are folks who would balk at paying 3967 for 9 months of physical activity, but I doubt it is the majority.

You don't get out much, do you? A sizeable portion of the US population would never leave the couch if given the option. A torn ACL also generally doesn't impede basic mobility much, and if your job depends on it or there are other extenuating circumstances you will generally get treated more quickly. Regardless, with the Canadian system the option to trade money for time is available; you can wait and get it done for free or if you have the means you are free to travel the US or elsewhere and get it done ASAP. That choice is not available in the US.