Maybe we need a two-tier system in which only basic medical care is assured. That will make it an affordable public expense. But, if you want the more expensive stuff, you have to pay for it with a combination of insurance and co-pay.
Isn’t Medicare that two tiered system. Basic Medicare gives basic care. Then one can buy Medicare supplemental plans to cover a higher %age of costs, and provide additional benefits.
My supplemental will cover 100% of what Medicare doesn’t pay after the Medicare deductible, and includes medical, dental, vision, hearing and RX coverage.
My choice of type of coverage and carrier…and cost. There were less and more expensive options.
So tell me, why can’t this type of plan be available to everyone?
thumber yes
Tatin- the Canadian system is Medicare for all. The US system is Medicare for everyone over 65.
It’s weird–there’s this chorus down here in the US trying to tell Canadians how bad their healthcare is, and they’re all like–what are you talking about?>>>>>>>>
When we finally (hopefully) get universal healthcare here, there will definitely be a pretty steep learning curve when it come to waiting for procedures. But we’ll get past that.
Interesting theory.
I would like to note that people are substantially ill-informed about what constitutes “good” medical care. Mostly, they make their decisions off how “likable” the personnel are.
Considering that, most Canadians probably don’t have any way of knowing how bad or good their healthcare really is. What would they compare it to?
International researchers, however, do have ways of evaluating different countries’ healthcare. Maternal mortality in the US is a scandal.
Well, I believe @alwaysamom provided her experience and observations as a U.S. citizen living in Canada.
I hope you understand that’s a small subset of “most” Canadians.
Yes, one person is a small subset, but there are plenty of Canadians living in the U.S. and plenty of U.S. citizens living in Canada who have experienced both systems. @Alwaysamom is our resident CC experience who provides helpful insight. I’m sure there are others on CC who would qualify, but don’t read the Parent’s Cafe as consistently as she does.
Because Medicare was always based on a cost shifting system. I believe the original calculation was 4 full pay private patients would cover the loss of 1 Medicare patient. Medicare simply does not reimburse enough to cover cost. It didn’t when it was implemented and it certainly doesn’t now. We are already seeing a decrease in the number of practices that will take Medicare assignments.
In another thread I detailed my own investigation into the matter. My private insurance paid (well, I paid since I had to meet the deductible) $330 for a procedure for which Medicare would reimburse about $50 !!! THIS is why this type of coverage can not be implemented for all. Unless of course the reimbursement rates get increased to meet the current private insurance payments. The situation is being made worse because ACA exchange plans also tend to have lower reimbursement rates. Hence, fewer provider participants in the networks.
http://news.heartland.org/newspaper-article/mayo-clinic-makes-medicare-medicaid-cuts
Providers OVERBILL other patients to make up for their Medicare/Medicaid losses. How do you propose to extend this type of system to all? There would be no patients to make up the losses.
The list goes on http://www.modernhealthcare.com/article/20150213/NEWS/150219952
Your average Canadian, even ones who have lived in the US, don’t know how medical outcomes differ in US and Canada.
@JustOneDad well…it sounds like you think you have the answers…so do tell!
Have you lived in Canada or any other country with socialized medicine. What is your source of expert information?
I guess you didn’t get that it doesn’t matter where you have lived. I might know something about health outcomes. They’re probably going to get more important here in the future.
People who want to know might do well to study the contributing components of Maternal Mortality as just one example that was mentioned here.
@teriwtt Thanks for the comments. I have pretty much given up on this topic because there are some who are not interested in the facts. They prefer to think that the crazy situation in healthcare in the U.S. is preferable to anything else. No other country could possibly be doing anything better than the greatest country in the world.
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I grew up with socialized health care in Europe where everybody is insured via a certain percentage of their income (usually the patient pays 7 or 8 percent of his or her income, the employer contributes another 7 or 8 percent) or via the government if unemployed. Retirees keep paying their 7 or 8 percent monthly. Private health insurance is only available above a certain income threshold. Nobody can opt out of health insurance, it is mandatory. It looks like Medicare to me.
While I do like this approach for general care, I have to say that the quality of care I encountered here in the US, either via an employer-sponsored plan or as a self-payer (being insured in Europe and reimbursed later) in three different corners of the country, is a lot higher. Doctors here are more professional, have a better bedside manner and are usually more connected to current research than any of my childhood doctors. This is even more true for my husband who is from a less developed country with some socialized health care access. Both of us will take American care over that of our respective home countries any day. Access to health care and the quality of it are different things. Access just isn´t enough if the patient receives incompetent or late treatment.
I am grateful for having wonderful doctors and a very generous HMO via my employer but I always try to remember that this a fairly new concept, maybe since the late 19th century (?). My grandparents certainly did not have health insurance until the 1950s and just saw and paid the village doctor.
I totally agree with you…totally.
On the flip side, I have experienced Canada and Costa Rica’s health care systems. I’d take both of those over ours because, you know, I could actually access those.
I’ve found no difference in quality of care.
The idea of insurance came about in the late 19th, early 20th century as mostly a way of protecting employees against accidents. It wasn’t really health insurance as we think of it now until the 1930s-ish. The idea of universal coverage was floated in the US until the AMA opposed it and it was dropped.
The rest of the global north took a different approach and have the health statistics to back up why it was a better position for the whole population.
Are you referring to outcomes and other facts about the healthcare system, or something “crazy”?
In earlier decades, medical care was not so scarily expensive, so that a much greater percentage of people could self-pay their medical bills. Of course, there were far fewer expensive procedures that one could have done, so many things that would result in expensive procedures today would have meant making sure that your last will and testament was up to date back then.
Employer-provided medical insurance is a legacy of World War II, when wages were frozen, but employers could increase benefits like medical insurance. Now, it is pretty much an expected part of the compensation package at a “good” job, reinforced over the decades by the employer tax deductibility of the premiums and the fact that many employees were uninsurable individually (both of these meant that paying employees more but having them buy their own insurance would put the employer at a disadvantage in attracting employees). Of course, in the immediate pre-ACA days, people outside of employer or government insurance plans had to deal with by-then very problematic individual insurance market.
Here is an excellent ten part series on health care quality in the US, compared to the other G8 countries minus Russia, by Dr. Aaron Carroll:
http://theincidentaleconomist.com/wordpress/how-do-we-rate-the-quality-of-the-us-health-care-system-introduction/
Spoiler alert: we aren’t winning the gold, silver or bronze on most metrics.
His series on cost is excellent as well.
http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/
Spoiler alert: We spend too much on almost everything.