Health Insurance In America

You can get fairly reasonably priced travel insurance here - and one of the first things those carriers do is ... fly you back to Canada. The guys I'm dealing with are either covered by Worker's Comp or our plans, on top of their OHIP. I think we keep some air ambulance services in business.

I remember hearing of some concern, here in the states, about full coverage health care making it too easy for people to go to the doc's too often and for trivial problems. Some went so far to say that people went more often than they needed to just to get their money's worth.

Does something like that happen in canada? It's a different situation there, but I can see a problem. An 'It's readily available and very low-cost, maybe we should go in at the drop of a hat' mentality.

Diane - I know that for some very specific diagnoses, OHIP will pay for treatment in the U.S. There are timelines for treatment of some types of cancer, and if the treatment can't be offered within the required timeframe in an Ontario hospital, they'll send you to the U.S. U.S. hospitals will always bump the well-insured to the front of the line (or at least that's my perception of their marketing pitch to us).

With a previous employer, we used to send people to Buffalo if we wanted non-essential MRI's done within 48 hours. You can get an emergency/essential MRI here immediately, but there is a one to two month waiting list (sometimes) for non-essential service. If I was trying to figure out what was going on with a claimant, and his doc either didn't want to make the OHIP referral, or didn't think it was essential, I could just make the arrangements in the U.S. myself, and then send the results to the doc for review. There are now a couple of private MRI facilities here, so you can get fast non-OHIP service now.

It's not low-cost, it's no identifiable cost. OHIP is part of our taxes, so you don't get a breakdown of the OHIP cost. (so you can't really figure out your money's worth) I think the experience here is that people (for the most part) go in when they need to - there is definitely more preventative medicine practiced - which means lower overall costs. If you can prevent a serious illness with a couple of occasional, inexpensive, check-ups - you're nowhere near the cost of treating a serious illness.

I am very unhappy with the state of the insurance industry. My policy keeps getting dropped by more and more doctors.

That's good Beth.

Edgar - dropped? What do you mean?

We got a message from the Kelsy-Seabold people that they will no longer honor Etna insurance. There is a dwindling list of people who will accept it.

Edgar, that is what has happened with my insurance. I have had to call ten doctors once while trying to find someone who would take United Health Care. So many plans delay payments for as long as possible, making it very tough on doctors. They also set caps on rates charged by doctors, physical therapists, etc. One physical therapist I went to said that she stopped accepting insurance and simply charged much less than normal. She said she still got more for her services than she did with insurance payments.

can't you switch providers?

Diane, we have problems, in comparison though, I think I prefer our system.
Each province health care system is unique and is administered locally, under the auspices of fedral government laws and budget.
Common problems are; waiting lists to see specialists and have specific procedures done ie. MRI. ( Diane, this might answer your question....).
Some hospitals have long admission times. Rural medicine is another consideration, some towns/areas even cities have trouble attracting doctors. Health care professionals don't make nearly the same wages as their american counterparts although, most make a good living, and live comparable lifestyles.
However, I would counter each criticism with similar complaints I've heard of in the States and almost every other country I've ever heard discuss the problem. Our medical treatment is second to none and Canada has been responsible for many scientific breakthroughs.
Every Canadian, regardless of stature or bank account has access to excellent care. Subsidies are given to those who can't afford premiums.

There are 12 (emergency/full scale) hospitals and roughly 40 medi clinics or varying capabilities in my city and area, of roughly 1 000 000. This city is the largest trauma centre in northern canada, and services most of the artic, the northern praires and BC.
Each hospital has specialities, ie children, pregnancy, burns, pallative, cardiac ect and each has an ER. All billing, ordering, outside contracts, food prep, hiring, firing is done centrally.
The concept of free market competition in first line health care is ludicrous. I understand drug companies, supply companies have to make a profit, but it makes sense to consolidate services and big business knows this. So why not be more efficient .

Littlek, I am covered by my ex husband's insurance--so I'm not sure I'll have any by this time next year.

Ceili, Canada's system is far and away preferable than ours in the US. As long as emergencey cases can be handled promptly, most people can afford to wait to see a doctor. In fact, many doctors here are so backed up that there can be a wait of months unless it is an emergency.

Capitalism has become so inhumane that I no longer find anything admirable about it.

My company picks my provider. They do it with an eye to spending as little as possible.

A few years back I got a spasm in a back muscle. It hurt worse than just about anything I've ever endured. But when I said the word "back" they all said they had no appointments available. I had to go outside of my insurance to see a doctor. By the time I got to his office the spasm had subsided completely and never returned.

Diane, Canada is capatalist country, not the socialists many americans would believe us to be.
Our health care system would not work without capatalistic interests. Businesses need to make a profit, Doctors need to make a profit. But who needs to make a profit off a hospital, the idea is morbid. I liken health care to education. There is room for capatalistic endeavors, private industry but, not at the expense of the user. I believe there are certain services that should be universal and should be run/controlled by the government.

As with so many things, few here in the states are willing to accept a middle of the road compromise (at least not in their rhetoric). It's all or nothing.

I can't believe the amounts you talk about.

We pay medicare levy as part of our tax. 1.5% of nett wages on my earnings. If a doctor "bulk bills" as the medical centre that I go to does, then the visit is free. Public hospitals are all free. I pay $80 dollars a month for private cover (on which I get a 30% tax rebate) which allows me to choose my own doctor in a public hospital, avoid waiting lists for elective surgery, or get treated in a private hospital. The private cover also subsidises dental visits, and eye wear. Eye testing is free.

Prescription medicine is subsidised by the government under the pharmaceutical benefits scheme. Average prescription (such as antibiotics) costs around $20. Unemployed and pensioners pay a maximum of $2.50 per prescription.
The medical centre also does xrays, CT scans and a few other things, which are also free. You have to pay for that stuff if you get it done by a private provider. I had a CT scan done privately 18 months ago that cost me $70. Anything done as part of public hospital treatment is free.

I should mention, my fees are based on a family not a single person.

Fishin' all or nothing always seems to be the block to sensible health care. Reading Ceili, Beth and Wilso makes me wonder if we in the States are all sitting on our brains!

When I read of people here going without medical care, pain medication or other, needed prescriptions because of no health care, I think it is truly criminal.

I guess I was fortunate because I didn't have to pay anything for my health care insurance when I lived in the USA. The fact I was single with no dependants likely factored into it. I believe some of my co-workers with families had to pay a percentage. My employer covered 100% of the insurance fees. I had a $5 copay for drugs. I also had to pay a $25 fee for an emergency room visit because the hospital I went to was not associated with my HMO. I believe there may have been deductibles for some procedures and, of course, elective procedures weren't covered at all. (It's the same in Canada for electives.) I had no copays for seeing my physician. There may have been a copay for opticals, but I don't need glasses so it was something I never used. All in all I had very little out of pocket expenses for my health care while I was residing and working in the USA.

I feel the need to clarify a few points here for both Canadians and Americans.

In Canada health care falls under the jurisdiction of the provincial government. The federal government contributes of course, but it is handled by the province. Insurance differs from province to province in terms of the fees paid and some of what's covered. The provincial health care covers pretty much most of what a person would need. What it doesn't cover is optometry (except for kids in some provinces, as I've said, it varies), dental (unless there is a medical reason for it, i.e. not routine) and prescription medication. There are private insurance companies that exist which cover those areas and quite often employers will pay for these fees either in whole or in part. It's really up to the employer. From what I understand dental is quite typically covered for 80% of most costs with the patient paying the remaining 20%. Again, it depends on the insurance company. Getting back to the government backed health care in Canada, there is freedom in the sense that one can see any physician in the province. You don't need approval from your insurance company. You DO need a referral to a specialist from your family doctor, but I believe this is the case in the USA as well. Insurance fees are based on your previous year's income tax. So you either pay the full fee ($44 a month for a single person, no dependants, in Alberta, the province I live in) or a partially covered fee, or possibly no fee at all. I don't know about other provinces, but I don't believe it is legal to charge any sort of co-payment or fee for any service covered by health care. However, what is covered by health care in Alberta has changed with our present government. But that's a sore spot with me, so I won't get into that at the moment.

In the USA there seem to be a myriad of health care insurance options. I'm not fully acquainted with all of them except for HMO's since that was the health plan I had whilst living in the USA. With an HMO you are limited to which physician you see. It has to be someone either with the HMO (e.g. Kaiser Permanente) or on an approved list. HMO's seem quite restrictive in my opinion. You have copayments and then there has to be approval for various services or procedures.

American health care is a for profit business. Canada does not have the same outlook. That doesn't mean there aren't for profit businesses involved in the Canadian health care system, but they are balanced by the ideal of universal care.

Here is an example of an experience I had the night before I started my job in the US. I had a severe urinary tract infection that I needed to have treated. I couldn't avoid it. The pain was incredible. Fortunately I had taken out travel insurance before leaving Canada. I would have been out over $600 if I hadn't. The hospital I went to was a "non-profit" hospital. (Whatever that means. They were one of the best equipped hospitals I'd ever seen and it was a small 50 bed facility!) Just walking into emergency cost $232. The physician's cost was $290.61. (The E.R. docs didn't work for the hospital directly but an association that provided physicians for hospitals in that state.) The tests included a urinalysis for $34 and a urine culture for $33. I was charged an outrageous $28 for prescription medication to last until I could fill the E.R. docs prescription the next day. My time in E.R. lasted less than half an hour. Now I used to work in health care. More precisely in a medical laboratory. The laboratory I used to work for in Canada would charge just over $20 for the two tests that I was charged $67 for by a U.S. laboratory. In all fairness, it was actually the hospital who charged for the lab tests. I know the laboratory itself doesn't charge that much, so the hospital pads the bill. And for anyone who spends time in an American hospital, you get charged for everything -- even if it's a mistake. Let me give you a couple of examples. I had forgotten my tourniquet one time when I was in ICU for a blood collection. One of the nurses said "oh I'll get one for you" and proceeded to go to the supply room and open a kit which included a tourniquet. To my horror she then added the barcoded sticker from the kit onto the patients chart. I asked her if the patient was charged for it and she said yes. From that point forward, if I forgot anything I went back to the lab for it. Another example -- a nurse made an error by asking for plasma for a surgical patient. It wasn't that the physician hadn't asked for plasma, but typically when plasma is ordered the lab will not thaw it (it comes frozen from the blood bank) until the patient is actually going into O.R. Delays and cancellations can and do occur so thawing plasma ahead of time is a dramatic expense to be avoided. (Once the stuff is thawed it has to be used within 4 hours or discarded.) It turns out the patient didn't go into surgery that day. Even though I asked if it was going to be used, the nurse demanded the plasma be available. So who pays for it? Not the hospital but the patient's insurance company. Or the patient themselves if they aren't insured. I think that if an error is made, the hospital should be held accountable and pay for the costs incurred. Is it a wonder that American health insurance is so high and continually increasing?