Canadian Health Care

[Val Gretchev]

If anyone is interested, here is the budget for health care in Ontario for 2012. In a nutshell, it’s around 46 billion dollars most of it collected from taxpayers by federal and provincial income tax.
https://www.fin.gov.on.ca/en/budget/estimates/2012-13/volume1/MOHLTC.html

 

[jpanhalt]

I looked up some census data for Ontario: 13 million people in 2011 (12,851,821) and 4.6 million households in 2006 (4,555,025).

So that equates to about $10,000 per household per year or $3,500 per person per year for healthcare.

Do those numbers seem about right? Is your healthcare payment separately identified on your tax returns? (In the US, the Medicare tax is identified separately, but that is not the only source of revenue for our healthcare.) Is your budget adhered to, or do actual expenses typically exceed budget?

John

 

[Val Gretchev]

That sounds about right John. The premium charged in Ontario to supplement health care is a separate item on the tax forms and is non-deductible. It is only a portion of the total health care budget and is charged according to taxable income. Most of the money comes from transfers from the federal government to the provinces.

Here is an article I came across that is quite negative about the value received for dollars spent on health care in Canada.

**broken link removed**

 

[ronv]

Val, Does that figure include long term care like a nursing home?

 

[Val Gretchev]

I don't think so but I am not sure. Retirement homes are definitely not covered and are very expensive. There are more and more of them as the population ages.

 

[ronsimpson]

So that equates to about $10,000 per household per year or $3,500 per person per year for healthcare.

What is the cost in the USA? We need to compare!

Most people, with US health insurance, get heavily subsidized by their work. Those of us who are self employed, or unemployed pay 2.5 times more than what a large company pays. And we basically can not get insurance if we have a preexisting condition. If I could get insurance at only 30% more than IBM or GE pays I would be dancing.

 

[ronv]

Here is a link that has several countries. Matches well with Val's numbers.

https://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States

Another interesting number is the US Military cost per person is about $4330 vs the overall of $7500 and Canada's $3500.

 

[ronsimpson]

From the graph that RonV shared:
>Almost anything can be proves.
>The cost goes up 2x every 12 to 15 years.
>(Either the US has 1.8x higher cost) OR (the US is 10 years ahead in costs)

When the unions were powerful: In the US they forced large companies to pay for health. In Canada they forced the government to pay for health. (Thoughts from a man that has lived on both sides of the line.)

 

[3v0]

the US is 10 years ahead in costs

I think you hit the nail on the head with that one.

 

[Mr RB]

The problem with US health care is that it is run by the big corporations, and their goal is one thing only, to suck the maximum amount of money out of the customers as possible. These corporations ie hospitals/drug companies etc are known for working together to keep prices high.

If the health care system was government run then it no longer has the one and only goal of taking money from the patient. If the govt is footing a lot of the bill they look for ways to reduce costs, bring in accountability as to why things cost so much, and start looking at problems with the big companies supporting each others rip-off pricing.

It won't be an easy transisiton for the US going from the old system to a more civilised health care system, the powerful big corporations will be kicking and screaming trying to protect those easy, corrupt, megabuck profits that they have become so accustomed to.

 

[ronv]

Mr. RB,
I suspect your right. Part of it starts with the uninsured. They at least get emergency care and someone has to pay for that so it gets passed to the people with insurance or to the guy with a few buck off the street. So now the hospitals make a few bucks - as they should. Then comes the insurance companies with CEOs making a bundle plus the profits on top. Then the drug companies that sell to Canada for less than the US because of the buying power.
Would that make up for it? Don't know, but your right a lot of big guys would be hit hard if it were to change. With it staying in private hands it seems like the big companies all get a big windfall from the increase in people covered.

Just found this little tidbit:

Won’t this just be another bureaucracy?
The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.
The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%.
It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. With a universal health care system we would be able to cut our bureaucratic burden in half and save over $300 billion annually.

--------------------------------------------------------------------------------

 

[ronsimpson]

I keep hearing that people with out insurance don't pay, and whats why the price is high. When we need a doctor we get out a stack of 100 dollar bills. My neighbor had a hart attack. The hospital took his bank accounts, 50% of his wages and he lost his house. I think the hospitals are aggressive about getting payed. (unless you don't belong in the country then what can they do?)

In Switzerland, the first year, they started out with health care that was intended to only stop people from loosing their house. Very high deductible. Major medical only. This worked out so well it expanded to what they have today.

I have a son that is too sick to work. Once you are sick you can't get insurance. Ok he could but it will not cover anything related to his problem. What good is insurance if they exclude pages of things. Depending on who gets elected, the preexisting condition thing (may/may not) go away.

I certainly enjoy the low federal tax in the US. With the low wages I have now, I would gladly pay 2X more tax to get healthcare. If my wages go back up that would not be a good trade. There have been months this year where I only made enough to cover the insurance. This last month I made twice that the insurance costs. For me the question is insurance or food.

 

[jpanhalt]

The problem with US health care is that it is run by the big corporations, and their goal is one thing only, to suck the maximum amount of money out of the customers as possible. These corporations ie hospitals/drug companies etc are known for working together to keep prices high.

Apparently you don't understand our healthcare system very well. You seem to be talking only about the payment system. Even in that event, you forget that to mention the Federal government (Medicare and various government insurance programs as mentioned above) and state government healthcare programs, including Medicaid. Of course, insurance companies are big, that is consistent with the concept of "insurance" and spreading the risk. Government designed and directed Medicare is abut 25% to 33% of most practices. Some are much more.

As pointed out much earlier, our current reimbursement system was created by our government. Do you really think that government will do a whole lot better after striking out so many times already?

It won't be an easy transisiton for the US going from the old system to a more civilised health care system, the powerful big corporations will be kicking and screaming trying to protect those easy, corrupt, megabuck profits that they have become so accustomed to.

I wish you would explain what you mean by that characterization. How can a reimbursement system be uncivilized? I take it that you think our quality of care is uncivilized and am quite irked by that suggestion. If you want an uncivilized system, a system that lacks compassion, a system that would rather let a child suffocate in the hospital than die peacefully with his family at home -- all because the Canadian government didn't want to spend the money to do a simple tracheostomy -- then look Baby Joseph's case from last year.

The American system shows compassion and our quality is a model for others. We took Baby Joseph into one of our church-affiliated hospitals and performed the operation. (The Canadian government was reluctant to let him even come here. Why? Were they worried about the politics and how it would look?) He went home and died several months later in the care of his parents. Do you know what it is like to suffocate? Should a patient's life be controlled by what is politically expedient. That is what I would call uncivilized.

John

 

[ronv]

Ron,

Same thing happened to my neighbor. His son got cancer. It was bad enough that he didn't have insurance but then he had to pay 3 times more than someone with insurance for the same treatment. He didn't loose his house but had to downsize. He was quite well off before.

John, Don't forget the other side of that coin. It is estimated that 18,000 people a year die in the US because they have no insurance. Insurance companies are saying profits are up because people are postponing treatment (fewer claims).

Val,
Is there a doctor shortage causing the long delays? Like maybe they cut to close to the bone on payments?

 

[jpanhalt]

Ron,

John, Don't forget the other side of that coin. It is estimated that 18,000 people a year die in the US because they have no insurance. Insurance companies are saying profits are up because people are postponing treatment (fewer claims).

Did you see this too?

Source:https://www.politifact.com/truth-o-...ll-says-22000-americans-die-yearly-because-t/

<snip>In other words, once you compare death rates in an apples-to-apples fashion — comparing insured smokers to uninsured smokers, for instance — the likelihood of dying evens out. This, in turn, would mean that IOM's estimate of 18,000 deaths would drop essentially to zero.

It would be more accurate to say, "In 2010, 2,437,163 people died in the United states (CDC data) and only 18,000 or 0.7% didn't have health insurance."

Claiming that the only reason people don't have health insurance is that they can't afford it is pure political BS. A lot of people indulge in risky behaviors, are irresponsible, don't plan for the future, don't save, and don't buy health insurance. Some people without health insurance drive motorcycles at night, on wet pavement, and without a headlight. For those people, it is not the cost, but their priorities. How many of the 18,000 died of gun-shot wounds or other accidental deaths for which the health insurance status would make no difference whatsoever ? Were those 18,000 deaths all in the hospital? If so, then then how did their insurance status even play a role?

John

 

[Mr RB]

...I wish you would explain what you mean by that characterization. How can a reimbursement system be uncivilized? I take it that you think our quality of care is uncivilized and am quite irked by that suggestion.

Admittedly I'm not an expert on your medical system by any means. But from my understanding having watched a number of media reports and the Michael Moore film (which YOU really need to see) the US system appears to be quite "uncivilised" (my term) compared to Canada, the UK and Australia, because in the US a great many people go without general care because they can't afford it, which is almost unheard of in the other English speaking countires. I'm not talking about highly specialised rare procedure but in general health care.

See what RonSimpson said about hsi neighbour having a simple heart attack and the hospital taking his house. That just does not happen in a "civilised" health care system, it certainly doesn't happen in UK, Canada or Australia.

...
If you want an uncivilized system, a system that lacks compassion, a system that would rather let a child suffocate in the hospital than die peacefully with his family at home -- all because the Canadian government didn't want to spend the money to do a simple tracheostomy -- then look Baby Joseph's case from last year.

Sure, there will be problems in any system and things will go wrong. But even with the excellent health care in Canada people can still buy comprehensive medical insurance to cover specialty stuff, and of course it is much cheaper to buy insurance than in the USA as so much is already free, the special insurance becomes cheap.

...
The American system shows compassion and our quality is a model for others. We took Baby Joseph into one of our church-affiliated hospitals and performed the operation. (The Canadian government was reluctant to let him even come here. Why? Were they worried about the politics and how it would look?) He went home and died several months later in the care of his parents. Do you know what it is like to suffocate? Should a patient's life be controlled by what is politically expedient. That is what I would call uncivilized.

I'm not going to argue one specific tragedy, in a world full of tragically sick people. I think you need to understand more of a big picture, and see how things generally go in other countries compared to how they generally go in the USA. Please rent and watch the Mike Moore documentary movie on the US health care system. I don't like his reporting style much, but he does cover a lot of the general differences between the extremely defective US health care system and the much superior health care systems of other English speaking countries. I was horrified to find out that a US citizen can be in a car accident, and then suddenly lose their home being forced to pay the bill, or a low income person refused medical attention, escorted from the hospital and dumped on the street in a taxi, sick and dying. Whether it irks you or not your health care system is like something from the dark ages. See the movie, see the comparisons.

 

[Inquisitive]

Then there was the issue of the "brain drain". Professionals in Canada found that their southern cousins across the boarder could make more money for the same amount of education. So teachers left, doctors left, most university grads had a whole new opportunity in front of them. Some headed south. This left a void. This was addressed by putting out a call to countries around the world. So, now a person in a third world country could find a better opportunity in Canada. When you compared the third world countries wage scale it looked good. I'm sure they still maintained the level of technical expertise.

Just thought I'd throw that out there.

 

[ronv]

A newer study covers some of your arguments, but I think we can all agree that treating early and at least treating saves lives otherwise we would have left it the way it was way back when.

https://news.harvard.edu/gazette/st...s-annually-linked-to-lack-of-health-coverage/

 

[ronv]

There is in fact a big difference in pay though it seems like all are doing OK once they pay for the education.

The average income after expenses, in U.S. dollars, for an orthopedic surgeon in the U.S. was $442,450, compared to $208,000 in Canada, $324,000 in the U.K. and $154,000 in France.

Provincial medicare agencies pay an average fee of $652 to surgeons in Canada for a hip replacement. Government programs like Medicaid in the States reimburse almost triple that, while U.S. private insurers offer an average of just under $4,000 per hip operation.

What is more, the U.S. has twice as many orthopedic surgeons per capita, providing about 35% more hip replacements overall.

Primary-care physicians include family doctors, pediatricians, internal-medicine specialists and obstetrician-gynecologists. Those in the U.S. earned an average after expenses in 2008 of $186,582, versus $125,000 in Canada, $159,000 in Britain and just $92,000 in Australia.

 

[jpanhalt]

Harvard and Michael Moore are cut from the same cloth. Ever hear the phrase, "You didn't build that?" That comes from Harvard too (Elizabeth Warren). I would much rather stick to verifiable data and facts rather than some activist propaganda.

Baby Joseph was a real person. His ordeal is well documented. How many thousands of others suffer and die in Canada, because its universal coverage provided only the care that an administrator thinks is needed? That is, only if you can wait. How many glaucoma patients in Canada progress with the disease while waiting for that appointment? You can count down the list of diseases and survival rates in Canada, England/GB, and the United States. The US is better in almost every case. Ironically, one result of the leveling done by the Canadian system is that people with more money get healthcare in the United States, rather than in Canada. Why would any rational government want to drive its more successful citizens to go elsewhere?

Those who claim the American system is uncivilized are dead wrong on two counts:

First, it is a baseless insult to the hundreds of thousands of Americans who work in that system everyday and provide the best medical care in the world. Sure, it is expensive in its current state, but that does not make it uncivilized. If Baby Joseph is just one example of how universal care fails, how about providing as clear a counter example of a person who died because he lacked insurance, not because he chose not to seek medical care or go to a hospital. There are several laws that require treatment to be given dating back decades. EMTALA is one of the more recent ones. It is often said that insult is the last resort of someone who is on shaky ground.

Second, the crazy reimbursement system we have is the result of government engineering dating back almost 50 years with many revisions and restarts in the interim. To say that the only way to get a better system is to put it in the hands of government after its many failures is simply repeating the same experiment hoping for a different outcome.

John