Health Insurance In America

fishin'

I read an article in the newspaper a few months ago that did a comparison of health care in the city I live in with a comparable city in the USA. (That turned out to be Oklahoma City.) I recall reading how one physician was frustrated because he wanted a certain diagnostic procedure done for his patient but the hospital didn't have that particular diagnostic instrument. Another hospital across town did, but they wouldn't allow a competitor to send a patient to their hospital. So the physician had to get his hospital to buy the particular instrument. (Something in radiology and out of my realm, I don't recall what it was.) He felt it was such a waste of resources to have two of the same pieces of equipment within a relatively short distance from each other, especially when neither were used to capacity. He felt it made much better economic sense to share resources. And he's right! But with a for profit system in place, you aren't going to see that sort of pooling of resources by competing hospitals. Another flaw in the American system.

I know Canada's system isn't perfect. Right now the waiting times for various procedures are atrocious. I shake my head and say "when did this happen? It was never this bad before!" The reason for the waits are due, in part, to government cuts to health care budgets. I should qualify my comments by stating that if you have a life threatening illness or anything that would cause you to become incapacitated or ill by having a delay, you are bumped up to the head of the line. My Dad had a biopsy and accompanying surgery within less than a week after seeing his doctor. He is cancer free today, thank goodness!

I suspect this article you read was written with a bit of a slant to it.

Typically doctors here in the US affiliate with a given hopsital and can refer any of their patients to that hospital for any tests, etc.. (Most doctors don't work directly for the hospital itself). If they aren't affiliated with a hospital then the hospital won't make it's services available to them and that sounds like what happened in the case you mention here. The hospitals don't care who the tests are perfomed on as long as the referring doctor is one that they are affiliated with.

But the doctor should have known that he could have referred his patient over to another doctor that was affiliated with this other hopsital and that doctor could have gotten access to the equipment and performed the tests. If he could only resolve the problem by getting his hospital to buy the equipment then that's short-sightedness on his part.

This story doesn't highllight a problem with the system. It shows that we have incompetent doctors that don't know how to use the system. Hospitals can and do pool resources all the time so I don't see how this is any flaw at all. It is VERY common right now for hospitals to set up 3rd party MRI facilities and all hospitals in an area refer all their patients to that facility instead of each of them having their own.

That's not to say that there aren't problems with our medical care system - there are - but the political football usually takes priority in dicussions of fixing the system.

I am uninsured. I just have to pay for my eye exams and I've forgone dential checkups altogether as I suspect most uninsured Americans have.

Even when I was insured, I was so worried about what was covered and what wasn't and the copayment that I once waited 2 days to go to the hospital for a broken leg. And I drove myself using an umbrella to reach the accelerator.

The $20 per visit copay for my physical therapy really added up considering that I went 2-3 times a week for several months.

I want universal healthcare in the US. The individual states should choose their own provider(s). Full coverage. All healthcare providers in the US should have to accept any state's insurance.

I'm not against copayments. In fact I think they're a good thing. They may cut down on frivolous visits but the target should be something like $1. Let the free market decide anything above that. So some places can charge a $20 copay if they want but they know that the majority of places I can go to instead charge only $1.

Something's gotta be done about malpractice insurance too. Doctors are fleeing certain areas and sometimes even the profession because they just can't afford it. I read that I think in Illinois malpractice insurance for neurosurgeons is half a million dollars a year!

Something has to be done about the cost of prescription drugs but I don't want it to come at the expense of R&D. Full prescription drug coverage would result in too much overcharging. Maybe federal matching funds for pharmaceutical R&D in exchange for more cost cutting measures like shorter patent lives?

Health Insurance in America
ehbeth posted earlier : "Boy, oh boy. I wish I could get hamburger to come in and post right now.
Diane, he was so concerned when he read about dys leaving the hospital because of the cost involved (well, partly, but you know). He couldn't imagine having to base a decision on medical care on the cost. Well, maybe he could remember what it was like before we had OHIP (Ontario Hospital Insurance Plan) that was a long, bad, time ago"
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( ... just arrived on the scene. absolutely had to do a posting under "ITZ ZE GERMANZ". hope you'll all have a chance to look at it.) i don't think i'll do a long posting, but try to break my thoughts and experiences up into a few shorter postings.
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here is some background info : i worked for almost thirty years for a canadian insurance company. the company sells mainly life insurance but also annuities and a fair amount of GROUP HEALTH INSURANCE (no individual health-insurance is being sold because the market for it is simply not large - profitable - enough).
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since mrs. h and i are retired and over 65 (would you believe it ?)) we are insured under the OHIP insurance plan at no direct cost.(OHIP = ontario health/hospital insurance plan). the plan is funded (some say underfunded) out of general (income) taxation and sales taxes. here is what it basically covers : visits to all physicians including specialists(referral needed for specialist), most basic prescription medications(but not asperin etc.), all hospital costs including surgery, recovery ... . here are a few other facts : emergency out of country medical expenses are covered at canadian rates (it is best to have additional insurance for out of country medical expenses ), personal note : in 2003 i had a little accident in germany (fell flat on my face ... no , i did not have a drink ! ) . transportation by ambulance, in-patient treatment, stitching, follow-up visit came to about EUROS 50(YES, FIFTY !) and i was reimbursed in full. ... if anyone is interested in learning about medical treatment as a "private patient" in germany, please let me know - in short, i was treated like royalty ! ... treatments not readily available in canada MAY be approved also. here is what is not covered by the universal health insurance : dental treatments, eyeglasses (but the cost of examination is), hearing aids, drugs that are not on the " approved list" - generally low cost drugs such as nosesprays, but also extremely high-cost (often experimental) drugs.
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persons under the age of 65 have the same coverage, EXCEPT for cost of prescribed drugs (but these are quite often covered by supplementary group health insurance provided through an employer). i think i'll stop here. perhaps more later on. hbg

For you Canajuns (and the Europeans out there!): How are things like elective surgery handled? I'm thinking of things along the lines of an elective implant, face-lifts, tummy-tucks, hair implants, etc..

If I decided that I didn't like the crow's feet around my eyes is that out of my pocket or... ?????

Canada, especially toronto is on the forefront of scooping american plastic surgery patients. There is apparently a continous line of americans coming up here for such procedures. The cost is much lower than in the states and the medical attention is on par.

OK, I guess what I was getting at is "Is it covered?" under programs like the OHIP? OR is it something theat you'd have to have private insurance for or pay out of pocket?

fishin

Even though that story may have had a slant, as you indicated, you will never convince me that the American health care system is superior to Canada's. I am entirely against a for-profit health care system. I worked within the for-profit system and it disturbs me greatly that there are those who go without health care because they cannot afford insurance. I believe that health care and education are two things that should not be denied anyone. Unfortunately this is just not the case for many.

You did make a comment that I'd like to address.


I wouldn't say the physicians are incompetent, I would say the system is so convoluted and complex and so bogged down with paperwork/procedures that it is not an easy system to work within. That in itself is a flaw of health care in the USA. I am not saying the care itself is not good. By and large it is amongst the best in the world. But it is not available to everyone and for a country as wealthy as the USA this is indeed a shame.

I never made the claim that it was nor was I trying to convince anyone of anything. I haven't dealt with the Canadian system myself so I have no comparison to make.

Ceili touches on a point I am familiar with. American health care costs are well above those in Canada. Almost every single test performed by the US laboratory I worked for cost considerably more than those same tests done by the Canadian lab I worked at. The Canadian lab I worked for (and I suspect this is the same for most labs in Canada) is a private laboratory that had to submit a bid to the provincial government to provide laboratory tests for the region over a period of several years. Regardless of the costs involved, they are bound by the contract to provide laboratory tests so the government isn't giving them money for each and every test done. From what I was told, the laboratory had to do private testing to maintain a profit. Private testing is not what you might think. It involves drug testing for industries (i.e. not for medical purposes) and they also do a lot of reference testing for small American hospitals closer to the border because they can do it cheaper than their American counterparts. (And yes this lab is certified by American standards necessary to provide testing for American hospitals.)

I can imagine that other areas of health care in Canada are also less expensive than comparable areas in the US.

To answer fishin', I imagine OHIP is like Alberta Health Care in that elective surgeries are not covered. However, they would be considerably cheaper in cost than having them done in the US. I don't know if private insurance would cover electives or not. I think some do cover some elective procedures, but I don't think any would cover something like a face lift.

fishin'



Okay, my mistake. My apologies.

"If I decided that I didn't like the crow's feet around my eyes is that out of my pocket or... ?????" sorry, fishin, operating the crow's feet is strictly up to the patient - a sharp razor blade should do. getting serious now : plastic COSMETIC/BEAUTY surgery is to the best of my knowledge not covered by the ontario health insurance. private insurance might cover it but i'd think the premiums would give you crow's feet prematurely ! plastic surgery to remove burn scars and similar is covered by insurance; eyelid surgery to correct turned in eyelids is also covered by insurance. hbg ... just a little addition : while the canadian system probably provides a wider coverage than the u.s. system(greater percentage of people covered) it is by no means perfect. there is some feeling that patients should be allowed to spend their own money to get faster access to medical treatment (if you are rich enough you can go to the u.s. or europe to get whatever treatment you want; would it not make sense to keep that money in canada ? this is certainly being discussed. ). hbg