Reality of American & Canadian Health Care-from one who has experienced both

[BigDrop]

Today has been an interesting day.  Retired, I have the time to spend hours a day following endless discussions of Obamacare, the Republican proposals and, interestingly, references to Canadian and European healthcare.  FWIW I was sr vp of sales for a Vancouver, BC company for over 20 years although I live in the D. C. suburbs.

Canada, as many others, has healthcare for all.

The wife of the man who owned my company feared that she had breast cancer.  Because of expected waits and backups in the Canadian health care system it was almost two months before she had a mammogram.  It was positive.  Ten years later she is doing well-the wait for the tests and the start of treatment was not too late.  Her husband, the man who owned my company, two years ago had issues with his vision.  After waiting more than a month for several followup tests he was told that he had a growth adjacent to his brain but it was thought that it was benign.  There was more than a month's wait for surgery and the expectation is that it would be a four hour procedure.  No matter what he and his internist tried he could not shorten the wait for the procedure.  Finally, he met his surgeon on the morning of the procedure (for the first time) which stretched to more than ten hours.  The tumor was benign and today he is fully recovered and although he lost a year of his life is just as sharp, smart and handsome as he was the day before this all started.  I am not sure of how much their total costs were but I do not believe it was very much in Canada's socialized system.

In the U. S.:

I had a three level spinal fusion three and one half years ago which led to my retirement.  I waited a month to meet my surgeon, another month for the surgery and spent my own year recovering.  The total invoiced cost which included two nights in the hospital was $149,000.  Medicare paid for the in hospital charges and Blue Cross and Blue Shield (more on this next) charged me a total of $5,000 for everything else.  Approximately $50,000 or so was the actual paid amount.

Today. my wife and I have concierge medicine which means that we pay more than a $1,000/year just to be able to see a particular doctor who is our internist and familiar doctor.  This is in addition to whatever he invoices Medicare/Blue Cross/Blue Shield and we pay as our co pay.  We have Medicare part A (in hospital) bu we do NOT have part B or D.  Because my wife was with our government for over 40 years we are able to continue with Blue Cross/Blue Shield PPO.  This makes an unbelievable difference.

Many doctors have limits on the number of patients they will see with Medicare because the amounts they will pay are so low.  Some doctors in various fields no longer see Medicare patients.  Others ask for or suggest supplimental fees such as concierge.  The result is that I can see my internist (family doctor) usually within 24 hours.  I can use any surgeon, any specialist that I want.  Either they are part of the concierge group or they accept BC/BS PPO.  Many, many no longer do.  Having said this I, as noted above, can still wait a long time for an appointment when it is not concierge.

A month or so ago my wife had a fever and, because it was Sunday, we went to our local hospital's emergency room.  They administered a number of tests, did blood work and, after four or five hours released her with several prescriptions.

We received the BC/BS statement a few days ago detailing our costs and what we would have to pay.  Total invoiced cost for the emergency room visit and various tests was almost $5,000.  BC/BS authorized approximately $1,500 of it which included several hundred which was our share.

The list price of that emergency room visit was subsidizing a lot of other people who went to the same emergency room and didn't have any kind of insurance.

1.  Canada/Germany/UK/much of Europe guarantee healthcare and deliver on it.  The common criticism is that there are waits involved and yes, there are.  I personally experienced it in my own life for two serious considerations involving my Canadian company.

2.  America is no faster.  Today there are waits involved in seeing almost any doctor in the Washingon, D. C. area, often as long as what Canadians experience.  A way around this is concierge medicine which is a $1,000+ per person upcharge per year that is becoming increasingly more common in the D. C. area.  And this typically only applies to one's internist/family doctor.

3.  Medicare and Medicaid have real limits on who will see patients using them, often allocating only minimal slots in their schedules.  I have been told by several hospital administrators that the fees that Medicare will approve, often, are less than what the hospital or doctor's actual costs are when they factor in various expenses.

4.  For anyone reading this:  it has become nightmarishly expensive to spend time in a hospital for a variety of reasons.  Even if you are 25 or 30 you should carry any insurance that you can find.  If you have to have in patient surgery and spend a few nights the actual cost could be more than your entire college education, even including living on campus.

5.  And the point of all of this:  what we experienced in Congress today was not just a political experience.  Medical expense and medical coverage in this and most other countries is one of the most important considerations we will ever have in our lifetimes.

 

 

[Belly Bob]

I appreciate the post. 

I'll add a few comments of my own, which aren't much, but they're all I've got. 

My best friend and his wife lived in the UK for five years when he was going to vet school there. They didn't have any serious medical issues while there, but they did go to the doctor's a few times. And each complained of long waits and that they felt like they were treated as mere numbers. Each preferred the healthcare system in the US and thought that it was worth the cost.

But I also found that people in the UK were shocked to hear how expensive medical insurance was in the US. The few I spoke with said that they'd prefer the UK system, given how expensive the US system was. 

And while there I also spent the weekend at a Scottish physician's house who told me after a few scotches that in his view it was criminal that in the US you could lose your house if you happened to get seriously sick without being insured, or if you got seriously sick and your insurance ran out. This was about 5 years ago. 

I agree that healthcare is a big, complicated issue that we should all care about. 

[HawgGoneIt]

I have nearly given up on the thought that we will ever have socialized medicine in the USA. I mean, we see the battle and fuss over just subsidies for health insurance as it stands now. 

Having a capitalist healthcare system has it's upside in quality of care and wait time, although I agree that unless it's an emergency situation, the waits to get in to see a doctor aren't all that short now. The huge downside is price. Some situations will certainly boil down to financial ruin for many, and that just isn't right. Basically, in the capitalist healthcare system, your health or that of your family is held hostage for whatever ransom amount the doctor wants to set. 

Another downside is that poor people will use the emergency room as their primary care and will never pay, therefore ultimately making the bill higher for those that do pay.There is no solution to that issue without socializing the system. Medicare/medicaid does a fair amount of covering a lot of people, but there are many more that don't fit the criteria for coverage provided by those social programs. Hospitals also offer some amounts of indigent care, but this again doesn't cut the proverbial mustard, and multitudes still slip through and just can't or won't pay. 

 

There was a time in this country when the doctors would barter a live chicken and a dozen eggs for services rendered and go home happy that they helped someone. Not today. Today many people have to work an entire week to pay for one visit to a specialist, or one visit to a primary care physician and the pharmacy after. Doctors charge exorbitant fees for spending something around 10 to 15 minutes with you. They then get on their little hand held, big pharma supplied PDA that tells them what medicine their sponsoring pharma company offers to treat the symptoms you displayed and send you along. It feels to me like being herded through like cattle on many visits with several different doctors over the past 20 years or so. Sometime before then, the services felt much more personalized and had an overall better feel for the price. 

There is something bad wrong with what we have now by way of healthcare, and I'm not meaning the ACA. Just the healthcare system in and of itself and profiteering off of sick children seems pretty wrong right on the surface. 

 

[NorCalRuss]

Health care is a very complicated situation. I see insurance point of view. Why would they want to cover pre existing issues when they know it could-will cost them millions of dollars. Costs are then passed on to those of us that are healthy for basic needs. That's not fair to folks that are healthy and only need basic care. Also see the point of helping those with existing conditions. They need care and that's the main issue to fix. How can we take care of those people without passing on extreme costs to "healthier" patients.  I don't use my insurance. It's basically there in case I have a major injury because I don't want to pay deductible. 

My wife is office manager of a surgery center and deals with this daily.  Everything in medical field is so expensive  . There's so many regulations : Have 2-3 nurses on sight ( pre-post and surgery) per surgery-$100/hr each, anesthesiologist-aprox $500-$1000/surgery, Scrub tech-approx $30/hr, sterile tech approx $20/hr. Then you have to pay the office workers, managers, directors, specialty cleaning, etc. Surgeries are $6k thru over $100k. This is for orthopedic ops, same day in and out surgeries.  Pain management injections they charge enormous amount more than what medication costs.  Medicare she says pays way more than private or cash. It's all very confusing if your not in business to me. 

In order to overhaul healthcare I believe you would have to start from ground up. That means lower costs on schools, training, equipment, find a way to lower cost on medication. Then the issue will be how many Drs, nurses, techs  will want to put in time at school  if they not making enough money.  

I dunno if there is a answer to solve this issue and make everyone happy? 

 

[HawgGoneIt]

7 hours ago, NorCalRuss said:

Health care is a very complicated situation. I see insurance point of view. Why would they want to cover pre existing issues when they know it could-will cost them millions of dollars. Costs are then passed on to those of us that are healthy for basic needs. That's not fair to folks that are healthy and only need basic care. Also see the point of helping those with existing conditions. They need care and that's the main issue to fix. How can we take care of those people without passing on extreme costs to "healthier" patients.  I don't use my insurance. It's basically there in case I have a major injury because I don't want to pay deductible. 

My wife is office manager of a surgery center and deals with this daily.  Everything in medical field is so expensive  . There's so many regulations : Have 2-3 nurses on sight ( pre-post and surgery) per surgery-$100/hr each, anesthesiologist-aprox $500-$1000/surgery, Scrub tech-approx $30/hr, sterile tech approx $20/hr. Then you have to pay the office workers, managers, directors, specialty cleaning, etc. Surgeries are $6k thru over $100k. This is for orthopedic ops, same day in and out surgeries.  Pain management injections they charge enormous amount more than what medication costs.  Medicare she says pays way more than private or cash. It's all very confusing if your not in business to me. 

In order to overhaul healthcare I believe you would have to start from ground up. That means lower costs on schools, training, equipment, find a way to lower cost on medication. Then the issue will be how many Drs, nurses, techs  will want to put in time at school  if they not making enough money.  

I dunno if there is a answer to solve this issue and make everyone happy? 

 

 

There is no answer that will make everyone happy. To me that puts us all in the precarious position of just simply doing what is right for the most people. There lies another problem, because people don't know what is right anymore. Profit is placed above everything in this day and time. Period. 

 

You touched on a lot of stuff like regulation, which is certainly something that adds cost to healthcare, but also adds safety for the patient. To me this again goes back to profiteering, because if the doctor wasn't so intent on making a huge profit, they wouldn't try to save money by failing to sanitize etc. If the companies manufacturing the medicines and equipment weren't so intent on making huge profits, the doctors wouldn't have to pass on such a huge cost to us. What about the equipment salesperson? He's marking it up and turning a profit as well. 

 

Schools are making huge profits to teach the science and art of medicine as well.

There are A LOT of people making really massive amounts of money directly off of the sick and infirmed. The real question is if that is the right place to make huge profits or not. There has to be a cap put on this stuff. It's as simple as that. Of course that isn't all that simple is it? 

I'm sure this is also where the point of contention will be, because as a society, we have exalted money and profits far above people now. A lot of us will go to our grave with our hands still reaching up and out of our casket trying to grab one more dollar. 

[TheRealCAJ]

6 minutes ago, Drummer61 said:

 and hopefully, will blow up...

It blew up in trump's face.

You or him offer nothing better.

You both are just old windbags.

 

[TheRealCAJ]

2 minutes ago, Drummer61 said:

You are incapable of ever adding anything  of substance to a post,rather display the pathology of an idiot.....You have no knowledge of facts and only bitch and rage,which is typical of a man who has manic pathology.....Your a punching bag for the constant idiocy you display and  hopefully,continue the raging of the uniformed fool that you are..The more you rant the more others see why you were thrown off another board......You remind me of the bell ringer  of Norte Dame and Sancho Panza....Neither of which you know about... You epitomize the far left zealots who are the low information voter of the world and exist in the cesspool of ignorance...

When you and trump offer a health care plan that works for everyone in this country you can have the floor.

In the meantime stop wasting this forum's time with your dribble.

 

[TheMaximumHornetSting]

11 hours ago, HawgGoneIt said:

I have nearly given up on the thought that we will ever have socialized medicine in the USA. I mean, we see the battle and fuss over just subsidies for health insurance as it stands now. 

Having a capitalist healthcare system has it's upside in quality of care and wait time, although I agree that unless it's an emergency situation, the waits to get in to see a doctor aren't all that short now. The huge downside is price. Some situations will certainly boil down to financial ruin for many, and that just isn't right. Basically, in the capitalist healthcare system, your health or that of your family is held hostage for whatever ransom amount the doctor wants to set. 

Another downside is that poor people will use the emergency room as their primary care and will never pay, therefore ultimately making the bill higher for those that do pay.There is no solution to that issue without socializing the system. Medicare/medicaid does a fair amount of covering a lot of people, but there are many more that don't fit the criteria for coverage provided by those social programs. Hospitals also offer some amounts of indigent care, but this again doesn't cut the proverbial mustard, and multitudes still slip through and just can't or won't pay. 

 

There was a time in this country when the doctors would barter a live chicken and a dozen eggs for services rendered and go home happy that they helped someone. Not today. Today many people have to work an entire week to pay for one visit to a specialist, or one visit to a primary care physician and the pharmacy after. Doctors charge exorbitant fees for spending something around 10 to 15 minutes with you. They then get on their little hand held, big pharma supplied PDA that tells them what medicine their sponsoring pharma company offers to treat the symptoms you displayed and send you along. It feels to me like being herded through like cattle on many visits with several different doctors over the past 20 years or so. Sometime before then, the services felt much more personalized and had an overall better feel for the price. 

There is something bad wrong with what we have now by way of healthcare, and I'm not meaning the ACA. Just the healthcare system in and of itself and profiteering off of sick children seems pretty wrong right on the surface. 

 

Me and you both know how GA's "Speacial" Health insurance works.... 

Its BS.... 

Im still paying my hospital bill....

[concha]

One wonders how much the costs here if the US would be if the government-imposed protections on drug prices and cross-border insurance were removed.

Here in the US we have about about 4x the number of MRI machines per capita than Canada or Chile (where I have lived). The US has about 6x the number per capita that the UK does (again, lived there). 

If you ever get cancer, you want to be in the US, with its highest survival rates in the world.

If you have run-of-the-mill ailments then socialized medicine is fine.  If you have anything serious and/or requiring immediate care, you do NOT want to have to rely on them.

[TheRealCAJ]

I'm no health care expert, but if we reduce the cost of a tab of aspirin from $9.00 to maybe $.01 we will be on the right track.

The rest is all BS from both sides.

 

[World Citizen]

6 hours ago, HawgGoneIt said:

 

There is no answer that will make everyone happy. To me that puts us all in the precarious position of just simply doing what is right for the most people. There lies another problem, because people don't know what is right anymore. Profit is placed above everything in this day and time. Period. 

 

You touched on a lot of stuff like regulation, which is certainly something that adds cost to healthcare, but also adds safety for the patient. To me this again goes back to profiteering, because if the doctor wasn't so intent on making a huge profit, they wouldn't try to save money by failing to sanitize etc. If the companies manufacturing the medicines and equipment weren't so intent on making huge profits, the doctors wouldn't have to pass on such a huge cost to us. What about the equipment salesperson? He's marking it up and turning a profit as well. 

 

Schools are making huge profits to teach the science and art of medicine as well.

There are A LOT of people making really massive amounts of money directly off of the sick and infirmed. The real question is if that is the right place to make huge profits or not. There has to be a cap put on this stuff. It's as simple as that. Of course that isn't all that simple is it? 

I'm sure this is also where the point of contention will be, because as a society, we have exalted money and profits far above people now. A lot of us will go to our grave with our hands still reaching up and out of our casket trying to grab one more dollar. 

I completely agree except for the last sentence.  Our last thoughts, imo, will not be anywhere close to thinking about money.  We might regret we spent so much time trying to acquire money and wish we had spent more time caring for the people we love. 

There is so much wrong with our capitalist system.  What allowed us to modernize and as a society lead the world in nearly everything will be what will cause us the most problems.  There is no way that people should worry about losing everything they have because they might get sick.  I truly wished that the Republicans didn't play politics with health care for the last 8 years.  If they had tried from the beginning to make the ACA a success and fix what needed to be fixed we all might have a really good system.  Republicans have good ideas as does Democrats.  Instead it was more important to start a smear campaign and just lie about the ACA and do everything to kill it.  Remember they said that there would be death panels to decide who lives and dies?  Now that the Republican crap bill had died, they say that the Democrats own it and I'm sure that Trump and the Republicans will now try to sabotage the ACA to insure it's failure.  

[Fred]

On 3/25/2017 at 8:17 AM, HawgGoneIt said:

 

There is no answer that will make everyone happy. To me that puts us all in the precarious position of just simply doing what is right for the most people. There lies another problem, because people don't know what is right anymore. Profit is placed above everything in this day and time. Period. 

 

You touched on a lot of stuff like regulation, which is certainly something that adds cost to healthcare, but also adds safety for the patient. To me this again goes back to profiteering, because if the doctor wasn't so intent on making a huge profit, they wouldn't try to save money by failing to sanitize etc. If the companies manufacturing the medicines and equipment weren't so intent on making huge profits, the doctors wouldn't have to pass on such a huge cost to us. What about the equipment salesperson? He's marking it up and turning a profit as well. 

 

Schools are making huge profits to teach the science and art of medicine as well.

There are A LOT of people making really massive amounts of money directly off of the sick and infirmed. The real question is if that is the right place to make huge profits or not. There has to be a cap put on this stuff. It's as simple as that. Of course that isn't all that simple is it? 

I'm sure this is also where the point of contention will be, because as a society, we have exalted money and profits far above people now. A lot of us will go to our grave with our hands still reaching up and out of our casket trying to grab one more dollar. 

You paint with a broad brush and still missed areas while overrunning others.  A doctor's practice has expenses that would make most people cry if it was their business.  Their insurance costs alone are huge because of the number of people trying to profit from anything and everything that might happen even if it might be 20-30 years in the future or happened 20 years ago.  I'm all for holding people accountable but when you act in good faith and to the best of current knowledge and something happens I'm not so sure the current multi-million dollar awards are appropriate.  Everyone in the chain gets sued and so their costs go sky high.  There are issues with intellectual property being stolen by state supported pirates so those real and opportunity costs get factored in.  I think drug companies charge a lot but I don't know the answer as they invest huge amounts to bring a new drug to market.  Clearly there are abuses like the Epi-pen debacle and no one denies that.  The life cycle to get a new drug to market is multiple *decades* long in most cases and the costs just keep on rolling.  IT requirements on medical practices are pretty steep as well and again that costs money.  The profiteering causing doctors not to want to sanitize or staff appropriately is reaching.  While true of some, most want to do the best they can and are very interesting in the welfare of the patient.

No, the schools aren't making huge profits to teach medicine, at least not at the MD level.  Nursing schools, at least good ones, aren't making money hand over fist.  I can't speak to the medical technology schools as I have no direct knowledge of them.

Profit is not a bad thing.  Businesses won't stay in business without it.  Lack of it is why you see so many rural healthcare facilities in such dire financial straights to the point they are having to close.  Even small hospitals are proving millions of dollars of charity care and the large one are pushing or exceeding $100 million.  It has to be paid for by someone.  I don't want to go into the whole immigration discussion but the strain placed on hospitals and ERs is real.  It is difficult to care for your indigent citizens when you also have to take care of people in the country illegally.  Finite resources can only be spread so thin.  I unfortunately got to spend a Friday night in the ER last fall (the day before the full moon to top it off and yes it is true about ER visits going up on full moons!) and while I mostly wasn't in a shape to pay too close of attention to everyone coming and going there were clearly lots of folks using the ER as their sole source of healthcare. 

Anyway, there is no easy answer.

[HawgGoneIt]

27 minutes ago, Fred said:

You paint with a broad brush and still missed areas while overrunning others.  A doctor's practice has expenses that would make most people cry if it was their business.  Their insurance costs alone are huge because of the number of people trying to profit from anything and everything that might happen even if it might be 20-30 years in the future or happened 20 years ago.  I'm all for holding people accountable but when you act in good faith and to the best of current knowledge and something happens I'm not so sure the current multi-million dollar awards are appropriate.  Everyone in the chain gets sued and so their costs go sky high.  There are issues with intellectual property being stolen by state supported pirates so those real and opportunity costs get factored in.  I think drug companies charge a lot but I don't know the answer as they invest huge amounts to bring a new drug to market.  Clearly there are abuses like the Epi-pen debacle and no one denies that.  The life cycle to get a new drug to market is multiple *decades* long in most cases and the costs just keep on rolling.  IT requirements on medical practices are pretty steep as well and again that costs money.  The profiteering causing doctors not to want to sanitize or staff appropriately is reaching.  While true of some, most want to do the best they can and are very interesting in the welfare of the patient.

No, the schools aren't making huge profits to teach medicine, at least not at the MD level.  Nursing schools, at least good ones, aren't making money hand over fist.  I can't speak to the medical technology schools as I have no direct knowledge of them.

Profit is not a bad thing.  Businesses won't stay in business without it.  Lack of it is why you see so many rural healthcare facilities in such dire financial straights to the point they are having to close.  Even small hospitals are proving millions of dollars of charity care and the large one are pushing or exceeding $100 million.  It has to be paid for by someone.  I don't want to go into the whole immigration discussion but the strain placed on hospitals and ERs is real.  It is difficult to care for your indigent citizens when you also have to take care of people in the country illegally.  Finite resources can only be spread so thin.  I unfortunately got to spend a Friday night in the ER last fall (the day before the full moon to top it off and yes it is true about ER visits going up on full moons!) and while I mostly wasn't in a shape to pay too close of attention to everyone coming and going there were clearly lots of folks using the ER as their sole source of healthcare. 

Anyway, there is no easy answer.

 

 

I agree that I was broad-brushing. It was intended to be an in general statement. 

I also agree about medical malpractice insurance and frivolous lawsuits. These are all place where ground can be gained on cutting overall costs to the patient/consumer. Another place where we agree is the illegal/migrants that come through and work for farms etc. Down here they have built them their own clinic where they get care, which keeps many of them from the ER, but still we are paying for it. There is no simple fix for that part either. Make the farmers that work the illegals pay? Then the tomato I buy costs me more. Same-same. Either way, I pay. We always pay. 

Any adjustments to the system are only there to make us feel better, because either way, we pay. If you socialize the entire system, we all pay, but we know and understand that we pay. If you leave it as it is we pay as well, just in different ways. Either way we pay. It's silly to not see that. We can all argue until we are blue in the face, have flat thumbs from typing on our mobile devices or the keys pop off of our keyboards, but in the end, WE ALL PAY. The only way you don't pay is if you never go to the doctor, or buy a prescription drug. I suppose there could be a few of those people out there, but not enough to have the battle royale over whether we pay for healthcare for everyone and everyone can use it without repercussions, or whether we pay for healthcare for everyone, and some have their credit ruined etc. in order to get care.