Canada/England - universal healthcare

[goinbatty]

For those that live where universal/national healthcare is provided, could you briefly describe how the system works - how is it funded (taxes/employers?), how the physician referral process works, what is required for authorization of procedures, etc.  In the US, this is a huge issue with the elections coming up.  I work for an insurance company and am very curious to hear from those that actually rely on that type of healthcare system.  Thanks in advance. 

[yardtick]

Okay, here in Ontario we have a health payroll tax.  Our employers submit the deductions and they also are taxed a percentage.  We have a health card that has our picture on it.  The newer ones also have a halo gram of our picture in the bottom right corner.  The back has our home address and a magnetic strip.  When we go to the Dr's or to the hospital we present the card.  The clerk than swipes the strip and all of your info comes up on a computer screen.  The clerk than asks questions to verify that all you info is the same.  Their computer system is linked up to OHIP (Ontario Health Insurance Plan).  All of the billing is done thru the computer.  Our family Dr's are paid monthly whether or not you visit the office. 

I personally have never had any trouble getting a referral.  I was seeing an ENT in the city I live and he did my first surgery.  Since he could only debulk the tumour on my facial nerve he referred me to a neurosurgeon.  This man had the personality of lint and the bedside manner of a Hitler.  I was not happy.  I was terrified and desperate and I stumbled across this forum.  One of our dear members PM me and asked where in Ont I lived.  I told her and see gave me the name and e-mail of her Dr.  I e-mailed him and he got back to me and said to have my family Dr refer me and he would gladly see me.  I had an appointment in 5 weeks.  I had to drive to Toronto, which is a major city with several outstanding hospitals.  (This Dr has two other brother's, one is a heart surgeon and the other is a pediatric neurosurgeon.  Proud parents I'm sure.)  He spent almost two hrs with my husband I.  He went thru my CT scans and MRI's, he was amazing.  OHIP paid for everything. 

I have extend benefits from work.  That covers all of my med's.  I pay $3.00 per script.  $250 every two yrs for glass and $1500 per yr for dental.  Root canals and bridges are covered and are above the $1500.  My husband and my fours sons are all covered under me as long as they are in school until the age of 25.  $500 physio, orthotics, so much more I can't remember it all I need my booklet.

Well I hope I answered some of your questions,
Anne Marie

[Denisex2boys]

Ditto to Anne Marie - - I am in Ontario as well and I can be referred to whomever I may suggest ...... all medical is covered - my Neuro. and (2) ENT's seem absolutely WONDERFUL!  I am also in a plan at work that also covers my entire family for .... perscriptions at 80% covered as is the dentist ..... I get $750. worth or chiro., massage therapy, podiatrist, naturopath, per calendar year.  Eye coverage (glasses) is $250. every two years.  I may also be able to put in a claim for SSD - we'll see!

[tony]

Hmm - In the UK we are taxed close to infinity
- Gas is 11-12 bucks per gallon,
 income tax at 40% plus a 10% pension levy kicks in
at about 25% above the "average" wage
many of our pensioners pay tax on the very benefits
that the same govt dept hands out.....
and many goods carry a 17.5% purchase tax
That said, the healthcare is "almost" free
- a two year wait for psycological support is not uncommon ?
(this is a weak part of the service)
MRI/surgery/radiowork is free (which is good)
Private stuff exists here .......but only Royals can afford it
Happy Day
Tony

[goinbatty]

Thanks for the info.  This election year is getting more interesting as time goes on.  At this point, who knows what willl happen. 

[Jim Scott]

When it comes to nationalized health care, the devil is always in the details. 

I don't want to see health care nationalized in the U.S. because I fear it will cost even more than we pay now, which, for my wife and myself, is about $2,500. annually for Blue Cross/Blue Shield medical and dental coverage - with very reasonable deductibles and co-pays.  That averages out to about $210. per month - for two people.  As most of us know, one night in a hospital can easily cost $4,000.  Aside form my AN experience, which ran in the rather posh neighborhood of $100,000., almost entirely covered by Blue Cross/Blue Shield, my wife has undergone numerous surgeries on her spine and neck, as well as a gall bladder removal and other, minor surgeries over the past decade or so, including one elective surgery that was also covered.  We get to chose our doctors (all outstanding) and are quite satisfied.  My wife's insurance company allowed me to remain insured under her policy, with full medical benefits, when I turned 65, as long as she holds the policy as an employee of her company and is under 65 (she's 54). We've had a few hassles with Blue Cross but they have been resolved.  Frankly, we're very concerned that with a government-run health care system, we'll end up paying more and getting less, as government bureaucracies are notoriously inefficient and basically unaccountable to the people they purport to 'serve'. 

Often, when 'everyone is covered', medical resources are spread thin and rationing becomes necessary, even if somewhat hidden.  I expect that many would-be doctors will pass on medical school and the arduous 12-year path to a physicians license if their income is limited by government regulations and many of their their patients are simply attempting to access that 'free' health care they're being taxed for every week. While Canada has many similarities to the U.S. in some areas, including household incomes, it is not a reliable indicator of what an American system administered by government would look like.  Canada's population is 10% of the U.S. and there are many differences inherent in the population base, including higher rates of disease and obesity in the U.S., for example.   I'm admittedly pleased to read that our Canadian AN patients are apparently satisfied with their health care system, although I've read that this satisfaction is not shared by every Canadian citizen, which is not surprising.  As Tony noted, the UK 'national' health care system is less than stellar - and the taxes that pay for it are brutal. 

I simply feel that private insurance companies, if allowed to operate in a genuinely free market, without government interference and without the government (via Medicare) setting artificially low fees for services and procedures that the privately-insured patient's insurance companies have to pick up (and then pay for with higher policyholder premiums) we would all be better off.  I don't believe indigent people should be neglected but they are essentially 'covered' now by virtue of the fact that no sick and needy person in America is turned away from a hospital.  Most states and localities have numerous programs to pay for health care for those who cannot afford it.  Our taxes pay for that - and most of us don't mind.  However, if all medical services are controlled by a virtually unaccountable government bureaucracy, I believe that the overall quality of our medical care will drop sharply due to overextension of resources.  I also suspect that we'll soon have a doctor shortage and will be 'importing' doctors from foreign countries in great numbers, as has happened in the U.K. as their home-grown physicians retire early or move elsewhere to secure better incomes and working conditions. 

Of course, I could be wrong - but I don't wish to gamble with my future access to quality health care and so, I oppose 'nationalized' health care or 'universal' health care schemes that politicians, most of them millionaires able to pay for 'private' health care, if necessary, want to impose on the American people 'for our own good'.  Also, should government-run health care ever become law, and fail miserably, as I suspect it would, we may never be able to go back to what we have now, which, while flawed, is not such a bad system and could be much better if government would simply get out of the way. 

Jim

[goinbatty]

Jim, I agree with the points you've made.  Also in the US, for the most part, to be covered under an employer's insurance plan and/or afford the premiums, one must work full time.  Without this incentive to work full time, what's to say people would work less and thereby decrease the tax base which would be supporting a universal plan.  I've asked friends that very question and most have said they would definitely work less.  Something to think about.....
Sandra

[oHIo]

I worked within our federal government's health care system (the VA) for 8 years.  All I can say is I DO NOT want our government having anything to do with our healthcare.  The thought gives me nightmares.

I currently have an HMO which pays quite well as far as benefits as long as I stay in network.  I have no out of network benefits.  I pay over $300 every two weeks for this plan and I am fortunate that I live in an area with a large medical center, multiple large hospitals and many specialists.  I work part time. 

My only out of pocket for my AN surgery was prescriptions and PT copays. 

It has been my experience that within the US healthcare system, we are somewhat spoiled (me included ) and have learned to expect short waiting times for appointments, procedures and tests.  We expect that when we need a specialist, someone will be there (usually locally) to care for us.  This could all change if our government decides to step in and manage our healthcare.  We are already having issues in our area with specialists leaving due to insurance reimbursement. 

Jim...I agree with all of your points.  I also know that a few hours in an ER can set you back a few thousand dollars if they do anything to you at all.  While no system is perfect, at this point I am fearful that change could be a detriment to our health care system.

[Raydean]

I"m not sure what the answers are, but i do know that private insurance is very expensive.  In 1998 we were paying close to $700. a month for 2 adults.  (Premera Blue Cross) by the time that I turned
55 years of age the same coverage jumped up to almost $1000. a month. This increase was based on my age, not actual costs. This was w/o dental coverage and included a large deductible (2500.)  Affordable health insurance is a huge issue.  Especially for those of us that are not covered thru work.  i know that I am one on the millions that are underinsured, not covered thru work, not old enough for Medicare, but old enough to fall into the higher rate bracket.  There has got be be a better way.  This is one area that I'll be watching closely during this election.  Affordable Insurance, with reasonable coverage and deductibles.   The number of companies that are covering health insurance is declining, so this will become a major issue as more people try to find affordable coverage. 

best to all
Raydean

[Jim Scott]

Raydean:

Thanks for your input on this vexing issue.

To address the rise in your medical insurance premium: insurance company rates are based on their experience and their risk.  Every state has an Insurance Commissioner whose office reviews insurance company policies, provisions and rates.  Complaints are usually taken seriously and investigated, often resulting in an individual rate decrease if the assigned rate (cost) cannot be justified.  I've availed myself of this service and been rewarded so I know it's effective, at least in my state. 

If the insurance company can prove - with verifiable statistics - that people over 55 file more claims and the company is then liable for higher costs when they insure someone over 55, the rate increase is considered fair, as long as it is not exorbitant, which can be a subjective definition.  No insurance company can legally raise your rate arbitrarily or single you out - personally - for a higher rate based on your age, alone, unless everyone they insure in that 'class' (over 55) pays a similar (higher) rate. 

You certainly have a point about those who are not insured through their job, old enough for Medicare and need health insurance but cannot afford it.  That is problematic.  However, I do not believe that having health insurance is a constitutional right that the federal government should be essentially taking over from the private sector. I know people who have fallen into the cracks in the system and they felt as many do, that 'the government should do something' so they would br 'covered'.  I can't blame them but I don't think mucking up the U.S. health care system to give perhaps 15% of the population 'coverage' is sensible.  I know that if I no longer could afford our job-related health insurance I would find a way to purchase it privately.  That might mean making a few minor sacrifices, like canceling the satellite TV service, not eating out as often or keeping the car an extra year...whatever it took.  In the final analysis, we do what we have to do to get what we want.  This is simple human nature.

The government forcing insurance companies to set unrealistic rates is akin to fascism, where the 'state' (government) allows businesses to exist under individual ownership but dictates their operation.  Even if this kind of health care/insurance were to exist, most insurance companies would either cease writing health insurance coverage or, if forced to do so at unrealistic rates, would soon face financial collapse.  The concept that some politicians have offered, that 'the rich' would be forced to pay higher taxes to fund 'affordable' rates for everyone is unrealistic.  Most rich people would simply move out of the country or move their money elsewhere (out of the U.S.) and will always find ways to escape onerous taxation.   Besides, although this is a wealthy country, I seriously doubt there are enough rich people to tax that would pay for the kind of pie-in-the-sky, everyone-is-covered-no-matter-what plans some politicians blather about.  I think it's mostly political rhetoric used to convince voters that this or that politician 'cares' and, if elected, will 'give you something' .  The truth is that there is nothing for nothing.  'Universal health care' just means that the vast middle class - the folks that pay the bulk of all the taxes, not 'the rich' - will pay a lot more in taxes to fund these schemes, medical resources will be stretched thin and the kind of medical care we now enjoy will be a distant memory.  But 'everyone is covered' and it's 'affordable'.  Sorry, but I believe in the individual taking care of themselves, whenever possible. 

Government has a role to play in health care but not turning the system upside down because a minority of citizens struggle to pay for health insurance.  There are many agencies in place that will help folks that need help.  Frankly, I would have taken a second mortgage to pay for my $100,000. AN surgery/hospitalization.  Would I have liked doing so?  No, I would have hated it - but I also don't believe someone else should have to pay for my medical care if I can find a way to do so.   If I couldn't find a way, I'm sure there are charitable agencies that would help and I would pay the doctor and hospital whatever I could over time, even if it took 10 years.  But that's me.  Others feel differently, I know and are hoping the next president & congress 'gives' them 'affordable' health care insurance.  Well, I hope whoever the president is, that he looks at the reality, chooses to remain true to our individualist spirit and admits that is not constitutional, financially feasible or even a very good idea.  I don't care what they do in Canada, a nation with one-tenth the population of the U.S.  They also are legally required to speak French in some sections of Canada.  Does that mean all Americans living in Louisiana should have to speak French? ( Sorry, that was strictly a rhetorical question).  I think not.  Speaking of the French, I guess I'm of the Laissez-faire school of economics but I'm extremely wary of the politically-driven 'national health care' proposals that promise much for little.  To put it in the vernacular of my late father (born in 1909): "Son, there ain't no free lunch". 

Jim

[Janet]

One of the reasons I decided not to wait for a surgical fix for post -op AN headaches was I was afraid we might get national healthcare. I felt that the surgery would not be allowed under a managed system. My insurance covered 100%. It was out of state but since the hospital took the insurance, it was considered in network. I was very surprised, as the hospital was on the east coast and I live on the west. I am so happy that I didn'twait.

I recently was visiting with my Canadian friend in Vancouver. She felt the care was rationed to the point of compromising care of patients. The up side to the Canadian system was that people seemed to take better care of themselves because they know they would not have treatment as available to them. I never really thought of that.

I have had 4 friends that retired early without considering the healthcare costs. They all manage to have insurance but not as good as when they were working. I think my husband will retire when we both qualify for medicare.

Janet

[yardtick]

Jim made a rather valid point about our population here in Canada and the French issue is a major debate much like your national health care issue.  All joking aside, here in Canada if you live in the populated areas you have access to outstanding health care.  In the more remote areas is where people suffer. 

I met a lady on line from the North West Territories and she had a 4cm AN pressing into brain stem.  She was diagnosed up there, flown to Edmonton and than flown to London General for her surgery all within a week.  When she was well enough to travel she was flown back to Edmonton for her PT and than flown home after.  All of this was paid for by our health care system.  She now has a yearly MRI done in Edmonton and she is doing well.   

We do receive excellent health care.  I know even with the deductions coming off of my pay I am not paying $700 a month for my family.  I think the major issue with the US system is the cost of the non professional services.  If I am correct and you do not have insurance you receive your health care in a state hospital.  All professional services are covered, but not the non professional service.  The medication, the room, the testing, the bandages, etc.  My brother-in-laws nephew is a Dr in the Cleveland area and this is how he has explained the issue to us.  It is a known fact how inflated the non professional services are.  I remember watching 20/20 a few years ago and Tylenol was listed as being some outrages price like $30 a piece.  That's a problem.

Too bad we can't just bring in a chicken, a loaf of home bread or pie like they did on "Little House on the Prairie"  Someone is getting very rich off of these non professional services.

Anne Marie

[Jim Scott]

Anne Marie:

To address the salient issue of medical 'non-professional' services being ridiculously inflated:  I understand that the hospitals do this to cover their losses because Medicare pays them at such a low level that they barely cover their costs.  The cost of treating the indigent and, in some areas, illegal aliens, also drains the hospital's resources.  It's similar to what happens when movie theaters are losing customers.  They start charging outrageous prices for popcorn and soda to help balance the loss.  I'm not approving of these inflated charges, just making an observation. 

This is why I view the federal government meddling in our health care system as a bad idea...they always make things worse.  In my small city, we have two decent hospitals and they are both going broke and seeking to merge to stay operable.  It's not going to improve if the federal government takes over the U.S. health care system.  Frankly, I don't wish to debate the U.S. health care systems pros and cons or make pointless comparisons to any other country as I believe the U.S., with it's 300 million + population is somewhat unique and trying to compare it to Sweden or England or Canada is futile.  I also feel that, interesting as it may be, this topic is only tangentially germane to AN issues and I doubt many members will get much out of this discussion so I'll use this opportunity to bow out of it. 

Thanks to all who participated.  Now, back to our regularly scheduled program. 

Jim