<p>“works” is subjective for universal health plans. Say you needed sinus surgery, not life threatening but something that needs to be done. How long would it take for you get get into the ENT and have that surgery done in say, Canada?</p>
<p>I’m not sure what the number of people has to do with anything. Why wouldn’t those single-payer systems scale properly?</p>
<p>Belgium has 10 million people, France has 65 million, Japan has 127 million. All have universal, single-payer government health care. What evidence do you have to suggest that a scheme which scales from 10 to 127 million (a 12.7x increase) wouldn’t scale from 127 million to 311 million (a 2.5x increase)?</p>
<p>By the way, your estimate of “20 million” undocumented immigrants is way off. DHS and reputable private groups estimated a maximum of 12 million, and that number is shrinking, not growing.</p>
<p>
</p>
<p>And if you’re an American who’s just been laid off from his job and can’t pay the COBRA premiums, how long would it take for you to afford to have that surgery done?</p>
<p>All health care systems involve rationing. Single-payer just rations it differently, that’s all - based on the urgency of the patient’s condition rather than the condition of the patient’s pocketbook/insurance card.</p>
<p>Steve, it’s funny that you should ask about sinus surgery. I had lunch with a friend today whose husband saw his ENT yesterday about endoscopic sinus surgery. He has suffered from terrible sinus infections for years. His surgery is scheduled for March 23rd. He was offered March 9th but they’re going to be out of town for a couple of weeks. I’m not sure if this is the type of sinus surgery you’re talking about but that’s how long it took my friend’s husband. Oh, and he had scheduled the ENT appointment about two weeks ago.</p>
<p>I was at a week-long event where I shared a room with a woman who was a health care planner for British Columbia. It was interesting to hear about their rationing/central planning decisions. I hadn’t understood before that that Canada does not have “a” national health plan – each province runs their own, and services that are shortages in one province may be readily available in another. But, like most central planning, the planners don’t necessarily do a great job at estimating and meeting demand, a la the Soviets and toilet paper. Apparently in BC you can wait a good long time (6+ months) to get a knee replacement or a hip replacement, or your cataracts fixed, and so some residents travel to get one sooner. I’d guess that the vast majority of these specific services in the US are performed on Medicare patients – which is pretty much like single payer coverage – and I don’t think that many Medicare patients face much at all in the area of wait times for these things. (And, wait time doesn’t start until after the necessary MRI studies, which also take a good deal of time to get scheduled.)</p>
<p>There are absolutely problems with the US system, but I’m unconvinced that Canada has solved them. (Wasn’t just a year or two that one of the provincial premiers from Canada flew to Florida (?) to get some surgery when he wanted it rather than waiting?</p>
<p>Hops_scout, sorry, but the person who told you that story is sadly mistaken. She may have called for a regular appointment, and been told that the next available appointment was in two weeks, but she did not specify that she needed an urgent appointment for a sports injury. Standards of care at every military treatment facility in the country are for urgent cases to be seen the same day.</p>
<p>And even so, all she had to do was bring her child to ANY emergency room in ANY hospital, civilian or military, for a concussion, and she would have been responsible for paying $0. All she would have had to do was call Tricare within a day to report that the child had been treated at xyz emergency room.</p>
<p>I say that as the wife of a career military officer, and as the mother of three kids who, between them, have had three broken wrists, a broken elbow (happened on a sports field and was transported to the closest ER via ambulance) and a bike accident that resulted in one adult tooth knocked out and replaced, three others knocked to the side requiring oral surgery to stablize, and multiple stitches.</p>
<p>We have always gone to the closest ER, which has usually been a civilian one, and have never paid a cent.</p>
<p>
</p>
<p>Sure, if you’re rich, you can afford anything, anywhere, anytime. That doesn’t change no matter what system you’re under.</p>
<p>If you’re not rich (and most people aren’t), the difference is that in Canada, nobody goes bankrupt paying for their son’s chronic illness, families aren’t living in constant fear of losing their health coverage and mega-insurance corporations don’t skim billions of dollars right off the top.</p>
<p>I have no problem with health care professionals making a decent living. I absolutely have a problem with a system that gives the health insurance companies a significant motive to pay out as little as possible in claims to create as large a shareholder profit as possible.</p>
<p>
</p>
<p>The problem is that doesn’t meet the “standard of care” for concussion management. ER physicians (in the big picture) are some of the worst when it comes to concussions. </p>
<p>Like I said, sometimes I’ve had good experiences with TriCare and other times not so good. There are times where we get approved for so many visits that it’s just crazy and then other times we have to continually beg for more.</p>
<p>Oh oh oh, just read the last page and I love you people!</p>
<p>Originally from British Columbia, 10 years in US, now naturalized citizens, but all our family is in Canada and well cared for by “socialist” single payer medicine. Yes, it’s not perfect and sometimes people wait a bit for treatment for non life-threatening problems, but overall, after much direct personal experience on both sides of the border, we vastly prefer the Canadian system. Husband and I are grateful that in the case of a catastrophic health problem, we aren’t completely at the mercy of Anthem BCBS (the healthcare coverage chosen for us by my employer). We could move back to Canada rather than face bankruptcy due to medical expenses.</p>
<p>Here in Georgia, though, when I tell people the Canadian system is better, they think I’m lying or brainwashed. Y’all must be from blue states, I guess.</p>
<p>Hops_scout, one more thought. Every military treatment facility has at least one (usually quite a few) Patient Care Advocate. I look at them as the Mama Bear you wish you had. If a military family member feels she has been mistreated at any point in the health care system… by a physician or by a nurse or by an appointment person or by a receptionist… she should contact an Advocate, whose office will be at the military facility. A patient can walk in or call to file a report. the Administration in charge of the hospital or clinic takes those complaints VERY seriously, and change does happen as a result. I have filed a few complaints in my time. Once the Advocate said, “Follow me”, and accompanied me to the clinic that had mishandled some college related paper work, and stood there with me until the situation was fixed. </p>
<p>If you work closely with military families encourage them to make use of patient advocates to help them solve problems that can sometimes seem overwhelming. In the case of having trouble securing a timely appointment for an urgent problem, a call to the advocate (call the main line to the hospital or clinic and ask to be connected to a patient care advocate’s office) would have assured them an appointment that day.</p>
<p>“How long would it take for you get get into the ENT and have that surgery done in say, Canada?”</p>
<p>In British Columbia, two weeks. Under my health plan in Washington State, maybe as long as four months. </p>
<p>“Apparently in BC you can wait a good long time (6+ months) to get a knee replacement or a hip replacement, or your cataracts fixed, and so some residents travel to get one sooner.”</p>
<p>Who told you that? I had a major office of my business in British Columbia, and we have never had anyone wait longer than three weeks FOR ANYTHING. That includes integrated Parkinsons care (both allopathic and alternative medicine), knee surgery, cataracts, you name it.</p>
<p>In Washington State, it took my d. 8 1/2 months to get the knee surgery she needed - the insurance company (considered the best in the state) LIED about the credentials of the first surgeon, and named a surgeon on their “panel” to whom you couldn’t be referred. Docs are paid bonuses not to make referrals.</p>
<p>Now is the BC system perfect? Oh, pretty close. It could be better if they were spending 10% more than they do now per capita (which would bring it to under 70% of what we pay here in the southern colony.)</p>
<p>Way back in this thread, someone said that employers pay a lot. Well, our company (insuring 75 people now) just reduced our monthly payment per employee by $50 each (per month per employee) by agreeing to cover the first $500 per employee (per year) ourselves. So we save $600/employee by agreeing to pay UP TO $500/employee. It doesn’t make a lot of sense to me, but of course the insurer has transferred administrative costs along with the deductible. We provide some vision, some dental, and $20 copay PPO insurance to all employees (they pay 5% of the cost); spouses and children must be fully paid by the employee. </p>
<p>Our cost per employee is $275/month.</p>
<p>
</p>
<p>It would be hard to design a system worse than what we have in the US, which combines most of the disadvantages of private markets and socialized systems without getting the advantages of either. Higher government cost than socialized systems in other rich countries, higher private costs, lack of price transparency for those who self-pay (hard to benefit from a market when there is no price transparency), limited user choice (insurance plans are typically chosen by one’s employer), no incentive for users and providers to choose the best value (and plenty of incentive for providers to recommend more care even when it is not better care), people with no money and insurance using the expensive emergency room, large amounts of bureaucratic costs, etc…</p>
<p>Don’t forget large amounts of research costs. Some for better; some for worse I’m sure!</p>
<p>Ok…i wrote an e-mail to Dave Jones…insurance commissioner in California…</p>
<p>I have written to him before and I always get a quick response.</p>
<p>I like him quite a bit. </p>
<p>This is what he sent me today…</p>
<p>"Yes, here they go again. *And I have no authority to reject these rates. This is why I have been fighting to get the Legislature for over six years to pass legislation to give me the authority to reject excessive health insurance rate hikes. When I was in the State Assembly I authored a bill every session to give me this authority, and as Insurance Commissioner I sponsored legislation last year (AB 52) to give me this authority.</p>
<p>The insurers and HMOs have blocked these bills in the State Senate.</p>
<p>If the Legislature won’t pass this legislation, it’s time to take it to the voters. <em>There is a ballot initiative that is being circulated for signatures to do exactly that.</em></p>
<p>Here is how you can help. Go to JustifyRates.org or Consumerwatchdog.org, which has a link to the campaign website. Download the petition. Sign it. Mail it in.</p>
<p>Send an email to all of your contacts explaining that your rates are going up again and it’s time we gave the Insurance Commissioner the legal authority he has been fighting for so he can reject excessive rate hikes. Include a link to JustifyRates.org. *Urge your contacts to download and sign the petition and forward it to their contacts to download and sign.</p>
<p>We also need financial contributions to fund the petition gathering. There is information on the JustifyRates.org site about how to make a contribution. Please make a contribution, no matter how small or big, every bit helps.</p>
<p>Thanks for supporting our effort to rein in these excessive rattle hikes.</p>
<p>Dave
"</p>
<p>“Fact!
Health insurance premiums for California families
rose 153.5% since 2002, more than five times the
rate of inflation.”</p>
<p>“Fact!
Only four insurance companies control 71% of the California market, and they set premiums in secret, behind closed doors.”</p>
<p>UCB wrote:</p>
<p>
</p>
<p>This is really spot on.</p>
<p>single payor is the only answer, and until we just go with it, we will be stuck with this hodgepodge bizarro “system” we are currently trying to rube goldberg together.</p>
<p>I wish Nixon’s plan had passed back when I was a baby. Would have saved me a bundle by now. ;)</p>
<p>Mini – the woman I roomed with told me that – she was a senior planner in BC’s provincial health administration, so I assume she knew of what she spoke. (This was about 4 years ago now.)</p>
<p>Looking around, this report quickly comes up, commissioned by Canada’s various health authorities:
<a href=“http://secure.cihi.ca/cihiweb/products/Wait_times_tables_2011_en.pdf[/url]”>http://secure.cihi.ca/cihiweb/products/Wait_times_tables_2011_en.pdf</a></p>
<p>While it is a pdf I can’t cut and paste from, the first paragraph of the executive summary concludes, “In a recent survey of 11 countries, respondents from Canada were more likely than those from other countries to list waits to see a doctor or nurse, difficulty for getting after-hours care and waits for elective surgery as access challenges.”</p>
<p>The same report goes on to say that health ministers had agreed upon a goal of hip and knee replacements within 26 weeks. From the comparison chart on page 6, it looks like only 76% of the knee replacements met this goal in BC, which was better than the 57% in Manitoba or the 42% in Nova Scotia. Ontarians (?) fared the best – 89% of those folks got their new knees within 26 weeks. </p>
<p>YMMV, but I don’t find this particularly heartening, particularly in a report commissioned by the government.</p>
<p>arabrab, the survey in question was dominated by countries that also have single-payer health systems (Australia, New Zealand, Italy, France, UK, etc.), so if Canada is too low on that list, it would seem to be an issue particular to Canada, not a flaw in single-payer.</p>
<p><a href=“http://www.commonwealthfund.org/Surveys/2010/Nov/2010-International-Survey.aspx[/url]”>http://www.commonwealthfund.org/Surveys/2010/Nov/2010-International-Survey.aspx</a></p>
<p>Also, you keep harping on “time to elective surgery” without addressing the fact that at least everyone can get elective surgery - which is not remotely the case in America, because if you don’t have health insurance and you aren’t made of money, forget it, the wait time could be 10 minutes and you won’t have access because you can’t afford the bills.</p>
<p>A very telling question on that survey: “Confident will be able to afford needed care.”</p>
<p>The United States was dead last - only 58% of survey respondents said they were confident or very confident that they’d be able to pay for needed treatment. That compares to 68% in Canada, 73% in France and 90% in the UK.</p>
<p>The United States also rated below Canada in difficulty of accessing care after hours, had more than triple the percentage of people reporting an inability to pay medical bills (20%), more than double the rate of people reporting they skipped needed treatment because of affordability (33%) and twice the rate of people who complained about denial of coverage or billing problems with their insurance (31%).</p>
<p>Meanwhile, the United States spent 16% of GDP on health care while every other country in the rankings spent less than 11%. Sounds like a complete failure to me.</p>
<p>[Statistics</a> Canada: Canada’s national statistical agency / Statistique Canada : Organisme statistique national du Canada](<a href=“http://www.statcan.ca/]Statistics”>http://www.statcan.ca/) This is another and more complete source of Canada Statistics.</p>