The COST of dialysis, etc.

[Bajanne]

You are right, all working people pay a health levy - about 1%.  But it is worth it.

[angieskidney]

It's great to hear about all the people whose countries give them "no cost" healthcare.

It's not so great that most of the people working hard in those countries are paying around 50% in income tax, as well as VAT on many of the goods they purchase.
(I don't know that Canada is this way, but most of Europe is)

Those of you saying that you don't pay for your healthcare:  YOU ARE.  Thankfully your systems make your personal out of pocket expenses minimal - and that can be a God send.  It's not free though - to anyone.

When I lived in Germany the income tax rate was at about 49% - I believe it is higher now.  And when I'd go to the doctor, I might wait for several hours to see him.

Ya in my Province we pay 15% taxes .. oh wait it was just lowered last month to 14%!! Woot! but I would rather pay a bit all the time and have my health coverage guaranteed than get ripped off by health insurance companies in a country that knows it is in high demand because your health coverage is nill!!

Sandman keeps saying that I could get disability easily in the States or he can get coverage when I get over there even though I would rather him have coverage well in advance. I have asked my dialysis unit social worker to look into which dialysis units are best in the Philadelphia area and what is the best route to get coverage but she said she only knows Canada and not the States and told me just to research on the net but I have found very very little besides the typical "We are the best unit in the world! Come here!" type places...

[Panda_9]

I dont really understand. How am I paying for my healthcare (surgery, hospital admissions, tests, appointments) when Im not paying for it? 

[jdat]

I realize that the money in the end is always coming out of someones pockets ( the population in one way or another ).
Socialized care is very debatable.
But not to raise any controversies I believe the quality of care I am able to get here is superior than what I would have had in the United States. I am comparing my time with the clinics in the US and France and whenever I was in the US clinics I hated it.


This may come as a shocker to some of you and you might think I'm plain crazy with my stupid philosophical thinking but here goes. I am aware it raises a big moral dilemna.

Who is to blame or take charge of the seriously ill? The ones who did nothing wrong but live life and get hit with kidney failure, cancer, diabetes or what else.... the list is long.
Are they at fault? I think not
Said diseased person is innocent but why should they have to suffer more ( from a financial point of view ) than they already are when there is in essence no reason to blame them.

But at the same time, why should the cost of keeping these people alive come back to society as a whole?

Controversy controversy when you hold us close!

Sorry I ask myself too many questions and I need to stop reading philosophy books.

[angieskidney]

I dont really understand. How am I paying for my healthcare (surgery, hospital admissions, tests, appointments) when Im not paying for it? 

taxes.

But at the same time, why should the cost of keeping these people alive come back to society as a whole?

Controversy controversy when you hold us close!

Sorry I ask myself too many questions and I need to stop reading philosophy books.

Well, that is why I think taxes are a good way like in my country because no one knows if they may get hit with ESRD or have a child born with it or something that leads to it as in my case!   Since anyone can be hit at any time with any disease ... everyone should pay taxes ... it helps everyone in the long run. In my country I don't have to worry about the medical costs added to my already surmountable worries ..

[slothluvchunk]

The GST is a tax that you pay on most goods and services sold or provided in Canada. In some provinces, GST has been blended with provincial sales tax and is called HST.

The GST/HST credit helps individuals and families with low and modest incomes offset all or part of the GST or HST that they pay.[/QUOTE

Jdat: you're right, it is a very difficult issue to discuss fairly.  In the end, someone has to pay for everything, and none of us want to pay for things we shouldn't have to!   It's difficult to establish "who" should have to pay for healthcare in society.   I'm in a precarious position in that I'm fiscally very conservative, yet require help financially to be able to survive.  It's hard to argue logically that I'm "owed" this, though who of us doesn't feel compassion for those truly in need?

It's a difficult issue - I hope everyone understands I'm just enjoying the discussion about it - in an effort to better understand, and possibly shift my own thinking.  I'm not trying to argue with anyone.

Angie,
don't you also pay a VAT or some sort of consumption-based tax on all sellable goods?

Meaning, above and beyond sales tax, do you have another fee or tax associated with purchasing items (either domestic or imported)? 
The tax is collected somewhere - I'd be curious to know without a VAT or consumption-based tax what your average sales-tax rate is across the different Provinces.

After reading about Canada's income tax on their website, it seems there is something similar to the VAT, though it is called the GST (Goods and Services Tax), and lower income families can receive a tax credit to offset its cost.





EDITED:  Fixed Quote - Goofynina

[angieskidney]

The GST is a tax that you pay on most goods and services sold or provided in Canada. In some provinces, GST has been blended with provincial sales tax and is called HST.

The GST/HST credit helps individuals and families with low and modest incomes offset all or part of the GST or HST that they pay.[/QUOTE

Jdat: you're right, it is a very difficult issue to discuss fairly.  In the end, someone has to pay for everything, and none of us want to pay for things we shouldn't have to!   It's difficult to establish "who" should have to pay for healthcare in society.   I'm in a precarious position in that I'm fiscally very conservative, yet require help financially to be able to survive.  It's hard to argue logically that I'm "owed" this, though who of us doesn't feel compassion for those truly in need?

It's a difficult issue - I hope everyone understands I'm just enjoying the discussion about it - in an effort to better understand, and possibly shift my own thinking.  I'm not trying to argue with anyone.

Angie,
don't you also pay a VAT or some sort of consumption-based tax on all sellable goods?

Meaning, above and beyond sales tax, do you have another fee or tax associated with purchasing items (either domestic or imported)? 
The tax is collected somewhere - I'd be curious to know without a VAT or consumption-based tax what your average sales-tax rate is across the different Provinces.

After reading about Canada's income tax on their website, it seems there is something similar to the VAT, though it is called the GST (Goods and Services Tax), and lower income families can receive a tax credit to offset its cost.

Every Canadian Province has their own taxes on top of the GST (Goods and Services tax). Quebec has the forementioned HST (I believe it is Quebec since that was not a quote of mine) and in MY province we pay PST (Provincial Sales Tax).

I don't know what VAT is.




EDITED:  Fixed Quote - Goofynina

[slothluvchunk]

The VAT is a "Value Added Tax" - it's a consumption based tax.

Basically there are two times you can tax people: 
When they make their money, and when they spend their money.
Taxing at the back end, (consumption based tax) encourages saving, as you pay less up front in taxes, and more when you spend it. 
Here we pay a high federal income tax, plus a state income tax (unless you're in Oregon is it?), plus a sales tax (state, city, and county).

The Government would make much more if they abolished the federal income tax, and charged either a consumption based tax (just a high sales tax), or a flat rate tax for everyone.


The point is that we pay for our healthcare, whether up front or not. 
Just like here in the U.S., many think that because they don't personally write a check for their health insurance, it's free from their employer.  They don't realize that the employer has already figured this into their salary.


How do you find the Canadian standard of care?  I've traveled all around the U.S., and even out of the U.S. (Bahamas) for dialysis, and have had very different experiences in each clinic.  This is the reason I try to do as much of it myself as I can.

[angieskidney]

The VAT is a "Value Added Tax" - it's a consumption based tax.

Basically there are two times you can tax people: 
When they make their money, and when they spend their money.
Taxing at the back end, (consumption based tax) encourages saving, as you pay less up front in taxes, and more when you spend it. 
Here we pay a high federal income tax, plus a state income tax (unless you're in Oregon is it?), plus a sales tax (state, city, and county).

The Government would make much more if they abolished the federal income tax, and charged either a consumption based tax (just a high sales tax), or a flat rate tax for everyone.


The point is that we pay for our healthcare, whether up front or not. 
Just like here in the U.S., many think that because they don't personally write a check for their health insurance, it's free from their employer.  They don't realize that the employer has already figured this into their salary.


How do you find the Canadian standard of care?  I've traveled all around the U.S., and even out of the U.S. (Bahamas) for dialysis, and have had very different experiences in each clinic.  This is the reason I try to do as much of it myself as I can.

Taxes in each province is different in Canada. But in my Povince it is only 2 taxes that equal a total of 14% (7% + 7% ... used to be 7% + 8%).

But I rather be taxes then be sick and suddenly be screwed because you can't afford your health care.

I like my care here. I have no real complaints .. just things that could make it better. And EVERYONE here gets EQUAL care because we don't pay out of pocket right there.

[Mom3]

However it is paid for, costs are inflated for most if not all medical services and not REAL costs. I think the US medical system is basically broken, but that is just a personal rant.

I'd pay the taxes to know people could get what they need, and felt that way BEFORE chronic disease struck our family. That said I suspect most of the developed world is paying more than they really ought to have to pay while exorbitant profits are made. Meantime, preventative health care is neglected. And research is guided entirely too much by "profit"...

I could go on, but I'll spare everyone...

Mom 3

[slothluvchunk]

I think research has to be spurred on by profit, because research takes money, and for people to put money up, they will want money back.
There's nothing wrong with profit.  I agree that greed has run rampant, but I don't think adapting a "profit is bad" mindset is the answer.  It's people's desire to succeed that spurs innovation and research in these areas.

My Brother in-law is an eye doctor, and has so many restrictions places on him by the insurance companies. It's ridiculous -  Here we are in a privatized, free market, and he can't charge what his time is worth.  He either has to do work for free, or not spend the time he wants to examining patient histories and writing letters to their other physicians.  His time is worthless in the eyes of the insurance company, they only want to compensate for the eye exam itself.
A doctor who is willing to take pride in their work and do the better work than the other doctors should be able to make more profit - there's nothing wrong with that in my opinion.  But when he HAS to charge a certain agreed upon amount or face losing all Medicare patients (for example) there is something wrong.  Some eye doctors in our area (consequently the really good ones) have moved to private-pay only practices.  They can't get paid for their time if they take insured patients, so they take only patients who will pay out of pocket for their superior service.  So where's all the money going?  It isn't going to the doctor who's paying six figures a year in malpractice insurance.  It's going to the insurance provider, who is not only making interest on all that money, but cutting down their risk at the same time by getting rid of the patients who actually cost them.

Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage.  We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.

Our system is broken, or at least not nearly efficient enough.  But the answer isn't government intervention or more insurance.  If people would gravitate towards MSAs and HSAs (Medical/Health Savings Accounts) they would be saving their own money for insurance coverage, and be building equity in it.  Meaning that they're making the interest on their money rather than someone else, and can someday start withdrawing what they've accumulated if they've been healthy.

Again, I'm not sure what the best way to go about it is.

I think everyone deserves healthcare, but I also think that like anything else, if you want to pay for better service you should be able to.  That doesn't mean that the poor people get sub-standard care, it means that if "customer service" is important, I should be able to pay more and go to a "ma and pa" establishment - just like any other industry.

As for drug companies and their profits - the solution is simple (in my very ignorant opinion)
Start their 17 year patent when the drug comes to market, not when they first file for the patent (or make the patent period longer).  They spend so much time bringing the drug to market, that often times they only have 5 or 6 years to make back the $500,000,000.00 that they invested in its development.  With exclusivity only lasting for a few short years, they have to charge WAY too much for the drug.  Give them longer to recoup the money they put in, and I think they could bring things to market for a lot less, without the fear of joe-schmoe drug company creating the generic and profiting from all of their research.

Anyway - that's a long winded way of saying:  Thank God we're all alive and healthy enough to sit here and talk about this.

Good Vibes to all of you 

[Rerun]

This may come as a shocker to some of you and you might think I'm plain crazy with my stupid philosophical thinking but here goes. I am aware it raises a big moral dilemma.

Who is to blame or take charge of the seriously ill? The ones who did nothing wrong but live life and get hit with kidney failure, cancer, diabetes or what else.... the list is long.
Are they at fault? I think not
Said diseased person is innocent but why should they have to suffer more ( from a financial point of view ) than they already are when there is in essence no reason to blame them.

What about the drug addicts or alcoholics or those illnesses that are self inflicted?  They deserve the same health care as ESRD or Cancer?  I think NOT!  Most ER rooms are full of people who can't pay, and who are in there due to preventable causes.  I don't know the answer, but if I'm waiting to be seen and Druggie Dave is waiting to be seen, I'd like to be first.

As far as costs go, who determines what a "Profit" is.  More than it cost to make, but how much over the top?  I'm sure every Doctor thinks he should make more.  How Much More?  That is the question.

I hate it when I try to keep costs down like saying "I don't need such and such lab" and the nurse says "Well, you have insurance don't you?"  Like it is free!  Someone is paying for it.

[Panda_9]

I totally agree with you about "druggy dave" Rerun. I have seen a few get in before me in the ER, they get their little box of pills and piss off, like no tommorow. Yet I go in there, with #$%#@ peritonitis and end up waiting 10 $#%# hours to even be looked at by a doctor. They just dont know enough about renal, and it shits me because there are tons of renal patients there. The past few times Ive been in and self diagnosed a high K, I got straight in. I just hope if I had no idea what was wrong in that situation, that they wouldnt make you wait all day.

[Mom3]

But if we start thinking like that where do we stop?

Most diseases have a life style component! If we err as a society or individuals is it not better to err on the side of compassion? Who has not done something that they know is against their health or failed to do something that might improve their health? Something they know they should do?

Drug addiction is an extreme, but it doesn't happen in a vacuum and it is a sign of terrible suffering on the part of the person. Happy people with good lives might experiment a little bit but they don't become addicts to drugs or alcohol (a legal drug!) Where you find abuse you usually find factors beyond that person's control, like a history of child abuse, early poverty neglect, untreated mental illness etc.

Mom 3

[angieskidney]

Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage.  We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.

Our system is broken, or at least not nearly efficient enough.  But the answer isn't government intervention or more insurance.  If people would gravitate towards MSAs and HSAs (Medical/Health Savings Accounts) they would be saving their own money for insurance coverage, and be building equity in it.  Meaning that they're making the interest on their money rather than someone else, and can someday start withdrawing what they've accumulated if they've been healthy.

in my case, I am a Canadian BORN into Kidney Failure so any Health Coverage I would have to BUY I would be turned down for because of "Pre-exsisting Health Problems". ... But yes, I am a Canadian who must seek info about American Coverage because I am inlove with an American.

Maybe it will all work out somehow but people keep telling me how Canada is better than the US when it comes to health care .. why would I ever want to leave. But then someone said that the only ones saying this are the ones who aren't American citizens and the ones who flee to other countries are originally from the other countries anyway. (Correct me if I am wrong as I might have offly quoted this person wrong).

I totally agree with you about "druggy dave" Rerun. I have seen a few get in before me in the ER, they get their little box of pills and piss off, like no tommorow. Yet I go in there, with #$%#@ peritonitis and end up waiting 10 $#%# hours to even be looked at by a doctor. They just dont know enough about renal, and it shits me because there are tons of renal patients there. The past few times Ive been in and self diagnosed a high K, I got straight in. I just hope if I had no idea what was wrong in that situation, that they wouldnt make you wait all day.

In Canada Dialysis Patients who go to the ER automatically get in before EVERYONE else.. The dialysis nurse told me this and I put the theory to the test when I went in and sure enough, as soon as I said, "I am a dialysis patient" They said, "Oh! Okay, this way!" and brought me RIGHT in  (I knew someone who was in the waiting room and she wanted to know how come she was waiting for hours and I come in and get to go right in lol)

Could this be just another reason why I should stay in Canada?

But if we start thinking like that where do we stop?

Most diseases have a life style component! If we err as a society or individuals is it not better to err on the side of compassion? Who has not done something that they know is against their health or failed to do something that might improve their health? Something they know they should do?

Drug addiction is an extreme, but it doesn't happen in a vacuum and it is a sign of terrible suffering on the part of the person. Happy people with good lives might experiment a little bit but they don't become addicts to drugs or alcohol (a legal drug!) Where you find abuse you usually find factors beyond that person's control, like a history of child abuse, early poverty neglect, untreated mental illness etc.

Mom 3

You are right there

[sandman]

In Canada Dialysis Patients who go to the ER automatically get in before EVERYONE else.. The dialysis nurse told me this and I put the theory to the test when I went in and sure enough, as soon as I said, "I am a dialysis patient" They said, "Oh! Okay, this way!" and brought me RIGHT in  (I knew someone who was in the waiting room and she wanted to know how come she was waiting for hours and I come in and get to go right in lol)

Could this be just another reason why I should stay in Canada?

Pretty good observation but the reality is, the more severe and life threatening your problem is, the less time you have to wait.  See, hospitals in the US take it's ER patients according to how life threatening your problem is AND, how much can you pay for medical services.

[angieskidney]

See, hospitals in the US take it's ER patients according to how life threatening your problem is AND, how much can you pay for medical services.

That last part is the part that sucks ... I have always been poor

[sandman]

Yeah, im not exactly wealthy either.    But you make do with what is available to you.

[Panda_9]

Our ER also has the triage system which works well, but a lot of the time they seem to accept people in who should be sent to a GP.

[sandman]

I'm sorry but what is a GP?

[Panda_9]

GP = General Practitioner

[jdat]

I think research has to be spurred on by profit, because research takes money, and for people to put money up, they will want money back.
There's nothing wrong with profit.  I agree that greed has run rampant, but I don't think adapting a "profit is bad" mindset is the answer.  It's people's desire to succeed that spurs innovation and research in these areas.

Contrary to popular belief, in the U.S. people in need of emergency treatment are treated - regardless of their insurance coverage.  We have between 10 and 15 million patients in the U.S. proving this right now, who aren't even American citizens.

1.
While most of the medical innovation today comes out of research done in the United States, very little of it is used in the country itself because of this for profit model. New equipment and updates means trimming on profits and for profit clinics do not want to see a drop in that margin.
( I posted this in a thread a while ago. (Why is State-of-the-Art ESRD Technology Better Outside of the U.S.?):
http://www.aami.org/publications/HH/ESRD.Leypoldt.pdf
The main issues pointed out in the article preventing advances in the US are:
Regulatory Constraints, Educational Constraints and Economic Constraints ( for profit companies are the main issue preventing progress State side) on on Advanced Technology. )


2.
The theory of the medical code of conduct dictates that under no circumstances shall they refuse care to a patient but I will be one to attest that this is purely theoretical.
I was denied care on several occasions while living in the United States ( I am a US citizen btw ) because I had no insurance and I wasn't able to make a deposit for a couple hundred dollars.

[Mom3]

As I understand it, they have to "stabilize" or get you to the point that you won't die immediately if that is feasible. That doesn't really constitute "care" as most of us would think of it!

Mom 3

[angieskidney]

I am just worried that if I go to the States will I be screwing myself? I am from Canada.

[slothluvchunk]

in my case, I am a Canadian BORN into Kidney Failure so any Health Coverage I would have to BUY I would be turned down for because of "Pre-exsisting Health Problems". ...

This is only true if you are looking at private plans.  If you marry your gainfully employed love, or obtain gainful employment yourself chances are you'll wind up able to get insurance under what's called "open enrollment".


As for ER's treating only those in the most need, this is at least partially true.

Having worked in the ER, and having worked in Triage I can tell you that this rule logically only works if the person in front of you is in worse shape.  In other words, it's not as though they put you to the side just to wait for a potentially worse off patient.
Walk into most ER's in America in the middle of the afternoon, and you will find waiting rooms full of illegal immigrants waiting for their free healthcare.  Most injuries will be construction related (at least here in the wildly growing West), and not life threatening. 

We have a Lebanese friend whose father just escaped Lebanon to come here after his dialysis clinic was destroyed by Israelis.  He is not a U.S. citizen, and only has insurance coverage in Lebanon.  While he's not being waited on hand and foot, he is receiving periodic dialysis, and it is considered "emergency care".

ER's are concerned first and foremost with the urgency with which the care is required.  Yes there is attention paid to the patient's ability to pay, but this comes later.  It's silly to think that they wouldn't address this issue, as they are a business and need to be paid for their services.
It's not as though they will send you away with dangerously high potassium (for example) without dialyzing you because you're not "covered".




EDITED:  Fixed Quote - Goofynina

Might want to look again goofynina, it's not fixed right yet. - Epoman