Canada's Private Clinics Surge as Public System Falters

[Sikander]

Originally posted by Oerdin


No they can't. Nearly 50% of American hospitals won't even accept a patient on Medicare unless it is an emergency case where they legally must provide care. Imagine if you have a cronic condition like Aids or Cancer and you were trying to find a place which would take you. Be a second late with a payment and your private insurence company will drop you, no other insurence company will give you coverage for your "pre-existing condition", and the public coverage is such crap you'd be hard pressed to find a hospital near your house which would accept it.

Face the truth. America's healthcare system blows ass for everyone but the upper middle class and the rich.

America's health care system sucks most for people who don't have insurance but do have some money most of all. This is because they have to pay the "standard rate". People who have insurance pay lower rates that their insurance companies negotiate. Poor people pay nothing, but they are largely excluded from all but emergancy care. Their costs are mostly picked up by those who pay the "standard rate". This is quite a bit of money. The hospital where I work only collects half of what it bills (and this is in a wealthy town). So those with no insurance are billed for more than twice what they'd pay if everyone paid the same price.

As for Medicaid and Medicare, they are simply underfunded to the extent that hospitals and other care providers lose lots of money on them. This is a political rather than an administrative problem. Neither state nor federal government pay nearly enough to cover the costs of these programs. The large number of non profit hospitals are in a bind. On the one hand they are typically obligated by their charters to provide care to those enrolled in these programs. On the other hand it means that they have to screw all their other customers (including those who are marginally above the income line required to enroll in Medicaid) in order to pay what the government doesn't. In places where poor people are concentrated it has the effect of either driving these institutions under, forcing them to defend themselves by refusing care to those enrolled in these programs, or forcing these institutions to ration care to the poor similarly to the worst instances of the Canadian system.

It's easy to say that the government should simply fully fund these programs, but a look at the numbers tends to induce vertigo, especially when one realizes that demographic trends are going to swell the costs of even the current Medicare program to budget busting proportions in our lifetimes. What to do? Firstly we need to ditch Mr. Fun's sophistry about "the right to life" somehow meaning that we have a right to unlimited health care. Every life will come to an end at some point no matter how many resources are spent to extend it. A complex cost benefit analysis must be constantly updated in order for a society to decide how to best utilize its public resources in this area as well as all others.

To my mind the greatest waste in the current U.S. public health system is that it largely exists to serve the elderly. The elderly are the wealthiest segment of the population, by far the sickest, and provide by far the lowest bang for the buck in terms of quality of life improvement and life expectancy extension. We are far better off making sure every child in this country gets off on the right foot and stays there until they are able to care for themselves. Children are the group most likely to live in poverty, and in any event are completely dependent upon adults to take care of them. Money spent on care for children generates the most bang for the buck in terms of improvement in quality of life.

[Sikander]

Originally posted by Oerdin
I think it is very fair to say the American system doesn't work and the British or Dutch systems work far, far better.

They all work to some extent. Many would agree that the U.S. system doesn't work as well as the others you mention, but few realize or admit that most health care systems the world over are more effective because so much medical innovation is born of efforts paid for by the U.S. system.

[alva]

The British have a healthcare system? Since when?

[OneFootInTheGrave]

Originally posted by Oerdin


True, but most of Europe and industrialized Asia has a two tier system (I.E. a public sector giving universal care plus private supplimental insurance for those who can afford it) and it seems to work well. Canada should just copy them.

this Canadian commie style ban is a ... just a testament that any kind of extremisim is bad, even theoretically "egalitarian" one. Allow private companies to compete, but provide a well managed national health service. One will supplement the other.

[Arrian]

Summary of thread:

Neither the Canadian nor the American systems are all that great. Each has its advantages and disadvantages.

Maybe neither of us have it right?

-Arrian

[OneFootInTheGrave]

surely true, but it has to be worked on

Not exactly sure what is the best system, but Swiss have something similar to US however with the caveat that the insurance companies >have to< take on the patients. And everyone >has to< be insured. My wife's highschool friend got MS and she lives in Switzerland. Initially there was resistance by the insurance company to take her on, as she will be an obvious expense, and an "legal intervention" had to be "threatened" but than they took her on, and I believe that in those cases they sort it out with the government/have some kind of system that allocates required resources where the costs of care have to be covered.

Under normal circumstances they have the different levels of care/ depends how much you want pay to insurance of course, but the basic level is covered for everyone (or the state on their behalf, for unemploted etc I think) and you actually have a market for the service providers in all that so that some form of market efficiency is preserved in the whole system. (actually not read much about it, all I know is from friends, I will read a little to get to know more )

as for UK, despite enormous beaurocracy, the revitalization of NHS might be the best part of the current Labour government. Huge investment, while mismanaged to a certain degree, still manages to improve various service and access time to them + the day to day working practices are changing at an accelerated pace to more efficient methods. Just with regards to "fairness" UK system is really impressive, as they will take anyone on, and help them, so in that sense UK is the best you can get in the world - noone is denied. The downside of it - potential "unlimited demand" is not as bad as it could be, and after the current "revamp" of the service it seems to work better and better. The beurocratic mismanagement is much bigger problem that the demand itself. One thing though with such nationalized services is - once can only hope that the future governments will be taking the same stance and not let the service to rot, like it happend during hte Thacherite years and during John Major + early labour start. That is the downside of "state" it does not care all the time as a business making money does, too much leeway for complacany.

Nevertheless there is the option now to go private if you have the means and while it creates some problems, still I'd say that those have to be worked on and the two systems are certainly capable to complement each other very well to get to the goal which is quick and accessible quality health service for everyone. Not outside the reach of our societies, but better management (more than more resources) is needed to see it happen.

* just one example of total UK complacany was not having networked PC's in the local surgeries for communication until ~2-3 years ago. In a way unthinkable almost 10 years behind the business world. I am sure this was not the only one and thus I am sure millions wasted on such obvious inefficieny over the years. (using the old telephone/fax combination instead of e-mail). This has however changed during this current investment from Labour.

[Az]

. One thing though with such nationalized services is - once can only hope that the future governments will be taking the same stance and not let the service to rot, like it happend during hte Thacherite years and during John Major + early labour start. That is the downside of "state" it does not care all the time as a business making money does, too much leeway for complacany.

such policies can be understood easily, if you explain stuff by ideology. certain government WANT these services to be destroyed, so they **** them up, claim that they don't work, and then privatize.

[alva]

We still (more and more so) take on a lot patients from the UK (through the NHS because of waiting lists (from Holland aswell btw)).
Just about every patient who came here, said that, if in the future, they needed to go to hospital again, would prefer to come to Belgium again.

The UK still has a long way to go.

[OneFootInTheGrave]

well while it might, I am sure it is getting better.

I think it differs widly by area, where I live the hospitals are top notch and all of the services that one could normally require are quite near plus "the free for all" concept is amazing when it functions.

The problem is however that this is one of the richest counties - Berkshire, and well that surely has to have something with the level of organization/ability with the health providers/hospitals locally. It would be great if this level of service was available nationally.

Anyhow, just back to share an aricle/paper on healthcare in Switzerland which I got the impression is at the moment one of the best in the world plus it combines quite nicely the private providers with "total coverage". Article looks quite good now at the beginning, but I just started to read it. Anyhow one of the points is that they revamped the system in 1990's and that might be one of the reasons why it works well, but I have to read it all to understand it better.

oops - link - http://www.civitas.org.uk/pdf/Switzerland.pdf

[Odin]

Originally posted by notyoueither


As evil as the right to more food? Or any food at all?

Here in the US only the poorest of the poor cannot afford enough food to survive, and those people are taken care of by donations of nonperishable food. When it comes to healthcare, MIDDLE CLASS people are going BANKRUPT here because of medical bills.

[Fake Boris]

Originally posted by notyoueither
Incidently, can you show a source for the higher salaries?

He's right, doctors and nurses earn a lot here... I guess it may be because we have direct competition from the American job market, where specialist doctors are insanely rich.

[OneFootInTheGrave]

something I can hardly believe

In 1997 there were 406 hospitals in Switzerland. Of those
272 were public or publicly subsidised (not-for profit) private. Five were university hospitals. With 5.6 beds per 1000
population, the Swiss are amply provided with hospital beds. Lengths of hospital stay are comparatively high. Perhaps
because of this, the proportion of total health care expenditure spent on hospital care is the highest in Europe. Unlike
other countries this excess supply has not yet been reeled-in

more capacity than neccessary?!?

or this

One third of Swiss pharmaceuticals are on a positive list and are reimbursed by basic insurance, subject to a 10% co-
payment. All other drugs are either paid for in full by patients, or by supplementary insurers if applicable. The Swiss
pay heavily for drugs and there is now a drive to increase the use of generics. The government advises patients to ask
doctors and pharmacists to substitute their prescriptions with generics whenever possible.

clearly no pro-pharma lobby working there

and an excellent section on the problems, which is basically the spiralling cost for such high level of "basic" guaranteed cover

Culturally, the Swiss like to have the best, following only the USA in their adoption of new technologies. But can such
a comprehensive luxury, ‘basic’ benefit package be maintained for all? Some, notably including the insurers, suggest
that the ‘basic’ benefits packages should be thinned – distinguishing between the desirable and the essential. Thus
treatments for lifestyle and minor medical conditions may be limited, and there would be more room for product
competition beyond a restricted ‘basic’ package. Only then would the insurer cartel be broken up

will be interesting to watch how will all this be financed in the future.

anyhow the guy handing out all the criticisms said

Although Zweifel is very critical of Swiss healthcare, somewhat
paradoxically, he is also certain that they have come up with the best solution in the world. And rather than regarding
NHS style and centralised uniform social insurance style systems (such as the French) as beyond the pale, he believes
that they are a necessary stage, a good first step, on the way to something else – something better: enabled competition
and mandatory private insurance

which I wholeheartedly agree with and a big to the Swiss for leading the way.

[Agathon]

Man, I wish I had NYE's brain...

...I could spend my day playing with blocks and crayons...

[Sandman]

Hospitals aren't the only aspect of healthcare.

Suppose I want to see a doctor in the US. What are the scenarios?

[Zkribbler]

Originally posted by Drake Tungsten
I can't wait to get back to America, in terms of health-care at least.

This must mean you're either among the dwindling number of Americans who still have health insurance or else you're fabulously wealthy.