I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Alex C. on April 14, 2015, 04:43:38 AM
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At my dialysis center, there is a technician who told me a story about a dialysis center near us, that happens to be the closest center to the Canadian border. He claims that they have a Canadian patient who comes over to dialyze 3x a week, and pays CASH, because OHIP won't continue his treatments after age 70. He also claims that "many European countries" also take you off dialysis once you reach some per-determined age. Is this true? If so, please, post some specifics.
Frankly, I think this guy is probably just some "old crank", but I wanted to ask, in case there is any truth in his story.
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Ontario here, on OHIP and I've never heard of such a thing. At our local hospital (which is where one goes for in centre dialysis as there are no treatment centres like the US has) there are many people over age 70.
What may be happening here is that he lives in a border community without access to dialysis and chooses to go across because Canada won't pay for his travel?
I can't imagine paying each time. We went once to the US and it was $523 for one session.
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We went once to the US and it was $523 for one session.
The price is all over the map here in the US. My center gets about $245 since I went on Medicare. It was getting $445 when I was on private insurance, and I've had clinics elsewhere in the US bill (and actually get paid) as much as $5050 for a single treatment when I was on private insurance. And no, that five thousand is not a typo.
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I don't believe this to be true...something is missing. Canada absolutely does not stop providing treatment at any age. Bunk and more bunk...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
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...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
I'm fully supportive of universal healthcare for the US. But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland. Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money. So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...
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Socialized medicine does two things - it reduces the amount of treatment available, and forces everyone to get "average" access.
Those of us who are fortunate enough to get great access to top tier facilities through employer insurance and/or medicare are losers if the system gets socialized, as the current system puts us ahead of the uninsured, or people with fewer resources. Those who now have below average access and get some of the appointments previously granted only to those who can afford them are winners.
Any change to the system will create winners and losers, and it is unrealistic to pretend this duality does not exist.
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I kinda thought he'd been listening to certain "tea party" blowhards, and you people in Ontario have more or less confirmed my suspicions. I think next time he starts talking, I'll just tell him to not listen to Fox News so much....
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Socialized medicine does two things - it reduces the amount of treatment available, and forces everyone to get "average" access.
Those of us who are fortunate enough to get great access to top tier facilities through employer insurance and/or medicare are losers if the system gets socialized, as the current system puts us ahead of the uninsured, or people with fewer resources. Those who now have below average access and get some of the appointments previously granted only to those who can afford them are winners.
Any change to the system will create winners and losers, and it is unrealistic to pretend this duality does not exist.
This is confusing.... this just sounds like it gives everyone a level playing field... which, doesn't sound that bad to me...
I pay cash for dialysis when I go to the US... I get part of it back when I come home.. When I went to New York in June, I paid $600 per treatment.. anything else besides the treatment itself was extra... I had to take my own bandaids, and the techs didn't know how to use the gelfoam that I brought
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This is confusing.... this just sounds like it gives everyone a level playing field... which, doesn't sound that bad to me...
I've worked my entire life, and continue to work a 30 hour schedule while on dialysis. I have no interest in a "level playing field" granting equal access to those who have sucked off the public nipple their entire life; birthed babies at 15 and collected welfare/SNAP/WIC/EBT checks and not even tried to contribute to society.
My point was that a "level playing field" as you call it will create winners and losers; it will not simply elevate everyone to the highest standard of care those who can pay for it now get. "Level" will mean a reduction in standard of care for some.
Someone once said "From each according to his needs; to each according to his abilities". In fact, he wrote a manifesto :o
anything else besides the treatment itself was extra
Every dialysis center I've dealt with includes the bandages with the treatment as part of the base charge. They don't include special bandages like the ones you bring, or antibiotic ointment like Mupricin. Drugs such as EPO are billed as a separate charge item. Plus, you've been in this game long enough to know you have to watch the techs to make sure they get it right.
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I'm not sure that there is any such thing as a level playing field anywhere in life let alone health care. What I can say about my experiences with the Canadian system is that it has served me and many others very well. I have done home hemo in both Ontario and Nova Scotia and although Nxstage is not available to us, home machines most certainly are and home hemo or peritoneal is both encouraged and widely supported. Living in remote or rural areas, no matter the country, will never be the same as a larger urban area. I felt underdialyzed after my first transplant failed and within a week I was put on five days a week instead of three and felt somewhat better. I have had two transplants, one from a cadaveric donor and one from a living donor who is from the US but who came here to donate. Is our system perfect? Of course not. However in my experience we do quite well for the largest number of people and I am extremely grateful to live here. I too worked hard and as much as I could but know that not everyone can do so for health reasons and this does not make them slackers or less worthy than me. It makes me one if the lucky ones in ever so many ways. There are indeed differences between provinces and most likely this is true also for states in your country.
I know from my personal experience far more about the Canadian system than I do about the American one and am always happy to hear about anyone who feels that they are getting good care wherever they are. I'm always a bit surprised however by some of the things that I hear about the Canadian system that bear no resemblance to what I have encountered here in Canada since I first started dialysis in 1980.
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Thanks for your input, Monrein. My father's ancestry is Franco-Quebecois, and we have family members who do live in Canada, although the Canadian family member I most often talk with is a cousin form my mom''s side of the family. I will probably send you more questions, as I have them.
FWIW, despite all the right-side glorification of our health care system here in the US, we still leave a full 12% of our population COMPLETELY uninsured, and have a chaotic clown-car race of competing and infighting insurance companies to cover the rest of us who are not on public insurance. Whereas in Canada, any facility knows that your bill will be payed by the one and only health care provider, here, it takes an entire department of collections agents to figure out who will pay which piece, and at what rate, and at what percentage, and then to send out the bills, wait, and collect some of what they are owed. It's for this reason that we pay MORE per person, and yet receive LESS health care per person than in ANY developed country in the world. We pay as much per person for health care as they do in France, yet we don't get any of the elaborate and inclusive extras that they get, but we DO get thousands and thousands of collections agents a place to work every day.....
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Dialysis may be the one level playing field area of medicine in the US - everyone gets the same treatment (as CMS standards are also followed by private insurers) at the mediocre level that CMS has considered "adequate". Remember, the standard is "adequate" treatment for everyone, not "optimal". "Adequate" is why in-center is only 3 days a week instead of 3.5 days, and why there is resistance to giving you a bigger filter than the one that "adequately" meets goal.
Now, would you want a surgeon who is "adequate" or one who is "excellent"?
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So, Simon, I have to ask, are you saying that people like myself, who have been ill for the majority of their lives, and are unable to work because of it, unworthy of the same treatment as you get? Don't you think we should all get the treatment we need, regardless of how much we paid into the system, or if we are able to work a full time job?
Yes, I understand that it's not a level playing filed across the country in Canada, however, I get the same level of treatment as my neighbor, even if I'm on welfare and he's a millionaire. That's what I meant about a level playing field. Having money, at least in this province, doesn't mean you get better treatment than someone who doesn't have money. There is no "shopping around." Everyone goes to the same place. If you want better treatment, and you have the money, you donate your money to the hospital so they can get better equipment, and then everybody gets better treatment.
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So Noahvale, are you thinking that we have no choice or say or input over which doctor we see? This has not been my experience. When I need a specialist, I get a referral from my family doc or my nephrologist or gynaecologist or whatever. Then, if I find out during my research that there is someone that I would like to see over the one I'm referred to then I say so and I can go to them. I had a back surgery a number of years ago and asked for a surgeon that I had heard very good things about. My husband needs a knee replacement and he will check around and request a referral to a specific surgeon. Now of course, one might have to wait to see the surgeon of choice if he/she is really busy (I imagine this is also the case in the US) but no one tells me who I have to choose. I have friends who have been dissatisfied with their family doc and they have asked around, found another who is accepting new patients and changed over. I live in a big city and as a result feel that I have a lot of control over my care. The same may not be true for a person living in a remote area, smaller town etc but that is likely true where you are also. The government does not tells patients who their doctor must be and I'm not sure why you have this perception.
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I thought the money collected from those who "pay into the system" is distributed amongst those who need care, including the person who paid into the system. Imagine what it would be like if no one could or would pay into a system or, if there weren't enough people to collect from even though everyone needs care. As for waiting lists, personally, I would not want to have to wait very long if my doctor suspects a brain tumor or MS and needs to see the results of an MRI before deciding on the next course of action. And I don't want someone deciding for me as to whether or not I can or should be on a waiting list. I think the critical word here is "choice".
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I live in Ontario and I live in the big city of Toronto. Of course there are differences between provinces just as there are differences between States. Northern Ontario is not densely populated and obviously not always well served. I suspect the same can be said for many parts of your country and of individual states.
Prime Timer, our health care system is funded by our taxes and we don't have the choice to opt out of those any more than you do. Our government is pretty insistent on that, kinda like yours is. Personally I pay them happily. Emergency situations are dealt with pretty immediately. A suspected brain tumour or other emergency would not be on a waiting list. You could look up Canadian Heath care system on Wikipedia if you are really interested in how things work here. I have a Health card that I present to doctors or hospitals or medical labs when I receive care and that's it. This is in fact how things work in many parts of the industrialized world with some differences of course and some do better than others in particular areas. Canada's system does not include medication generally except for seniors but here in my province we have a program (Trillium drug program) that transplant patients apply for . It is geared to income and therefore my yearly deductible amount depends on my income in a given year. I find this to be fair and I am always very happy when I have to pay for more of my meds because it means that I've made more money that year.
Our system works approximately like your Medicare I think except it applies to all of us not just seniors (or people on dialysis).
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I did some reading on wikipedia about Canada's health care system. They had entire sections on... how prescription medications, among other things, including dental and mental health care not being covered, long wait times (but then they try selling you on the idea that sometime longer wait times can actually benefit a patient...say wha???), you have to re-qualify for care if you move from one province to another and sometimes the re-qualifying period is 12 months...yikes!. Wiki also included the fact that Canada's health care system places restrictions on privately funded health care (sounds like punishment to me) and a section about Canadians having to go to the US for care and (hold onto your seat for this one) not everyone gets the same level of care.
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So Noahvale, are you thinking that we have no choice or say or input over which doctor we see? This has not been my experience. When I need a specialist, I get a referral from my family doc or my nephrologist or gynaecologist or whatever. Then, if I find out during my research that there is someone that I would like to see over the one I'm referred to then I say so and I can go to them. I had a back surgery a number of years ago and asked for a surgeon that I had heard very good things about. My husband needs a knee replacement and he will check around and request a referral to a specific surgeon. Now of course, one might have to wait to see the surgeon of choice if he/she is really busy (I imagine this is also the case in the US) but no one tells me who I have to choose. I have friends who have been dissatisfied with their family doc and they have asked around, found another who is accepting new patients and changed over. I live in a big city and as a result feel that I have a lot of control over my care. The same may not be true for a person living in a remote area, smaller town etc but that is likely true where you are also. The government does not tells patients who their doctor must be and I'm not sure why you have this perception.
Obviuosly, you live in a wealthy, densely populated province.
"Already a destination for its beaches, palm trees and Disney parks, Florida can now add medical tourism to its list of attractions as more and more Canadians visit for surgery.
Long wait times are increasingly driving patients south, including two Albertans who underwent surgery on the same day last month, and commiserated about feeling abandoned by an ailing system back home."
http://www.calgaryherald.com/news/calgary/Long+Canadian+wait+times+send+patients+south+surgery+Video/9702357/story.html
"When it comes to waiting for health care, Canada is last in line
A major international survey says Canadians wait longer for health care"
http://www.macleans.ca/politics/when-it-comes-to-waiting-canada-is-last-in-line-2/
From a different perspective. Comparing Canada to other universal-access health care programs.
http://www.huffingtonpost.ca/nadeem-esmail/canada-free-health-care_b_3733080.html
Those who have the longest wait times in the States, are those who get care through the Veterans Administration. Ironically, our country's version of a single payer, government run healthcare system. Plus, veterans do not get to go outside the VA system unless the needed services are not offered or they wish to pay out of pocket.
I hope you are a voter. :thx;
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Per a study titled "The Effect of Wait Times On Mortality in Canada" released on May 20, 2014 by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank, Canada's growing wait times for health care may have contributed to the deaths of 44,273 Canadian women between the years 1993-2009. :'(
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I don't think wait times are any different in Canada than the US... if something is needed, it's done... I waited a week for my gallbladder surgery, but that was my choice, because the first surgeon that saw me was nervous.. he didn't really want to touch me because I was/am a dialysis patient.. he was the weekend surgeon.. I waited a few days for the weekday surgeon to see me.. he was younger, and less nervous.. then I had to wait a few extra days until there was an opening..
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...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
I'm fully supportive of universal healthcare for the US. But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland. Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money. So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...
Hello iolaire London here... I have not heard of a London dialysis-centre being closed down,
but there again I don’t really know how dialysis-centres in other London districts cope and what they (have to) do or plan ...
Concerning home-hemo: I have tried - from the very start - to „remain independent“, get my training and be able to „do“ home-dialysis,
but I was told it would be much better for me to have my dialysis-sessions in a dialysis-centre
because of my complicated health-history and my forthcoming transplant...
... and I also could be much better medically observed in a dialysis-centre... Mind you, that was five months ago... :waiting;
Best wishes and good luck from Kristina.
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I really can only speak about my own experiences with the health care system here Prime Timer, and I do wish that I had not needed to use the system as much as I have. Are there problems here that we need to address? Yes. And furthermore the issues will change over time. Our aging population will make increased demands on the system and I think that we need to learn from some of the other systems around the world. Most of my family live in Florida but I came here at fifteen and like it here very much. I've also lived in France and I held a US passport for most of my life. We all speak from our experience with the various systems that we encounter and within my family in the US, some are happy with their care while others feel that they pay an enormous amount for not very much really. They all seem to think that what I have here is very good indeed. Our system is not perfect and like everywhere we as patients must advocate for ourselves, do our best to stay healthy, educate ourselves about our medical issues and do what we can to contribute to improvements in our communities and our infrastructure.
You hope that I am a voter? . Of course I am. I consider my right to vote both an obligation and a privilege.
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...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
I'm fully supportive of universal healthcare for the US. But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland. Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money. So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...
Hello iolaire London here... I have not heard of a London dialysis-centre being closed down,
but there again I don’t really know how dialysis-centres in other London districts cope and what they (have to) do or plan ...
Concerning home-hemo: I have tried - from the very start - to „remain independent“, get my training and be able to „do“ home-dialysis,
but I was told it would be much better for me to have my dialysis-sessions in a dialysis-centre
because of my complicated health-history and my forthcoming transplant...
... and I also could be much better medically observed in a dialysis-centre... Mind you, that was five months ago... :waiting;
Best wishes and good luck from Kristina.
I found the site for that center and it closed down because NHS wanted to treat people in their own facilities. So something was mixed up in what I heard.
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I don't think wait times are any different in Canada than the US...
I have heard that there can be considerable delays in getting CAT/MRI/PET scans in Canada, especially for non-emergencies. Can anyone on the list enlighten?
When I needed an MRI (based on an Xray suggestive of AVN) here in the US it took three days - and two of those three days were waiting for the insurance company to pre-approve payment. Of course, the flip side to that is I only had instant access because of payment .... an uninsured person without cash up front (probably at several times the insurance paid rate) would not experience a delay ... they would be outright denied the scan.
If you need an MRI for him pain in Canada, how long will it take from the day your MD writes the order?
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"...our health care system is funded by our taxes and we don't have the choice to opt out of those any more than you do."
Good point. Whereas many people would like to treat health care like any other item you would purchase, looking for different prices, deals, different suppliers, etc., in that way of purchasing, you always also have the choice of doing without. OTOH, with health care, when you need it, you MUST purchase it, and the provider MUST provide it, regardless of your preparations. Last month, my dad fell and broke his femur. Hospital stay cost $30k, covered (mostly) by his insurance. Had he been one of those reckless people who CHOOSE to not buy health insurance, he still would've spent time in the hospital, still would've received surgery, but in the end, who would've paid, how much, and when?
Unless we wish to become sociopathic and deny medical care to those who lack or refuse to buy medical insurance, we need to have a system where payment is as assured as care is mandated. Single-payer or pubic-option health insurance creates a base-line of minimum accepted care and repayment for those services. It's not perfect, but at least it's there. We require people to buy flood insurance when buying a house, and for those who live in flood-prone areas, that insurance is almost always partially or fully insured by the US government PUBLIC flood insurance fund. We should do at least the same for human health insurance.
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...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
I'm fully supportive of universal healthcare for the US. But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland. Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money. So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...
Hello iolaire London here... I have not heard of a London dialysis-centre being closed down,
but there again I don’t really know how dialysis-centres in other London districts cope and what they (have to) do or plan ...
Concerning home-hemo: I have tried - from the very start - to „remain independent“, get my training and be able to „do“ home-dialysis,
but I was told it would be much better for me to have my dialysis-sessions in a dialysis-centre
because of my complicated health-history and my forthcoming transplant...
... and I also could be much better medically observed in a dialysis-centre... Mind you, that was five months ago... :waiting;
Best wishes and good luck from Kristina.
I would say, from personal experience in the UK (East Anglia) there is very little enthusiasm for home haemo
and I am a rarity!!! At our centre and satellite units there are only FOUR home haemo patients.
There is little encouragement for home haemo and it was difficult to access the training despite it being cheaper
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...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.
I'm fully supportive of universal healthcare for the US. But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland. Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money. So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...
Hello iolaire London here... I have not heard of a London dialysis-centre being closed down,
but there again I don’t really know how dialysis-centres in other London districts cope and what they (have to) do or plan ...
Concerning home-hemo: I have tried - from the very start - to „remain independent“, get my training and be able to „do“ home-dialysis,
but I was told it would be much better for me to have my dialysis-sessions in a dialysis-centre
because of my complicated health-history and my forthcoming transplant...
... and I also could be much better medically observed in a dialysis-centre... Mind you, that was five months ago... :waiting;
Best wishes and good luck from Kristina.
I would say, from personal experience in the UK (East Anglia) there is very little enthusiasm for home haemo
and I am a rarity!!! At our centre and satellite units there are only FOUR home haemo patients.
There is little encouragement for home haemo and it was difficult to access the training despite it being cheaper
The quote from my travel coordinator was wrong, she said: "Unit #2 closed their dialysis unit on March 31st due to NHS pushing for dialysis at home rather than in the centers." I guess that probably means she talked to someone and the message go garbled in translation from English to email..
But the website says:
Renal Unit Closure
The Renal Unit at the Hospital of St John & St Elizabeth is now closed.
This decision was made as a result of the NHS strategy to provide services in house rather than use a private unit such as ours.
http://www.hje.org.uk/index.php/News/renal-unit-closure.html
FYI if someone knows of a London center that likely would take last minute holiday dialysis patients, please PM me. I'm looking for the first week in May, two sessions.
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I would say, from personal experience in the UK (East Anglia) there is very little enthusiasm for home haemo
and I am a rarity!!! At our centre and satellite units there are only FOUR home haemo patients.
There is little encouragement for home haemo and it was difficult to access the training despite it being cheaper
1. HHD is cheaper, but users tend to live longer so there goes your profit. ;D
2. The NHS is (one of the) largest employers in the world. It's mainly the 'caring staff' that's likely to loose their jobs. Also the PFI programs (with Fresenius for example) meant that contracts have been signed to 'deliver' patients paid for by the NHS, so the investors don't like their 'milking cows' finding a way to live without them.. The 'caring staff' has no benefit with helping to create 'less work'.
So apart from the patient, nobody (financially) benefits.
Home haemo IS stimulated in the UK. Just not necessarily Nxstage.
One day might come that society as a whole would realise that society as a whole would benefit.
Love, Cas
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Per the Vancouver Sun news April 14, 2015 "B.C. residents wait longer for some surgeries"
http://www.vancouversun.com/health/residents+wait+longer+some+surgeries/10972098/story.html
Per the Winnepeg Sun news Feb. 9, 2015 "NDP can only blame itself for health-care woes" (according to the article, despite Winnepeg receiving increased federal funding, they're not spending the money wisely).
http://www.winnipegsun.com/2015/02/09/ndp-can-only-blame-itself-for-health-care-woes
Per the Ontario Sun news Jan.4, 2015 "Reality check-up for health care" (per the article, wait times can average 18.2 weeks).
http://www.torontosun.com/2015/01/04/reality-check-up-for-health-care
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I don't think wait times are any different in Canada than the US...
I have heard that there can be considerable delays in getting CAT/MRI/PET scans in Canada, especially for non-emergencies. Can anyone on the list enlighten?
When I needed an MRI (based on an Xray suggestive of AVN) here in the US it took three days - and two of those three days were waiting for the insurance company to pre-approve payment. Of course, the flip side to that is I only had instant access because of payment .... an uninsured person without cash up front (probably at several times the insurance paid rate) would not experience a delay ... they would be outright denied the scan.
If you need an MRI for him pain in Canada, how long will it take from the day your MD writes the order?
I can only go by my own experience in my own province, but I'll do my best to answer the question. Remember, I live in Canada's smallest province, Prince Edward Island, with a population of only 140,000 people.
I've had 2 MRI's in my life, both of them in the last couple of years. The first one was for my gallbladder issues. They were looking to see if the stones had passed, and if they hadn't, where they were. I was admitted to the hospital on a Wednesday, and had the MRI that Friday. I believe in that case, it was considered an emergency because the stones were blocking the pancreas and causing pancreatitis.
The other was to try and find out what was causing menstrual issues that I was having. It was done after a vaginal ultrasound attempt was unsuccessful. There was several weeks waiting on the vaginal ultrasound, but the MRI was less than a week later. This was not considered an emergency.
Although, I have been waiting a week for an appointment for an echocardiogram, again, not considered an emergency.
I believe wait times would be less on PEI, but we are short the staff to operate the machinery.
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Wait times are certainly one of the issues that we need to address and constantly reassess. Much depends on where one is and on what the wait is for. Wait times are not good and we hear a lot about them but they are usually for non emergency cases. This does not make them acceptable and as the population demographics change there will be increased pressure on the system. As new technologies become available and the expectations for treatment rise the challenges are indeed huge. I think that we need to look at how some other systems cope with the pressures without losing sight of the philosophy that underlies Canadian healthcare...universal access. I don't think that the American model of healthcare can provide us with satisfactory solutions because I don't think that profit and in fact pretty huge profits have a place in this arena.
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Who in the US doesn't have access to health care? How would doctors, nurses, techs and researchers be paid under a non-profit health care system? The government? And where does the government's money come from?
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Who in the US doesn't have access to health care? How would doctors, nurses, techs and researchers be paid under a non-profit health care system? The government? And where does the government's money come from?
Without wishing to get into a political debate, I CAN offer some information regarding your questions.
Everyone in the US has access to EMERGENCY hospital care. However, many people who do not have adequate insurance cannot afford ongoing care for more chronic conditions like diabetes or hypertension. It depends upon in which state you live and how Medicaid works in that particular state. The US has a patchwork of medical care.
And yes, in countries that do not have a for-profit care system, the government allocates money for healthcare, paid for with taxpayers' contributions. I lived in the UK for 20 years and had to avail myself of the NHS on several occasions. I was in hospital for 6 weeks during my pregnancy, at the end of which I had a C-section, and walked out without receiving a single bill from the hospital/doctors/everyone else who had a finger in the pie.
That said, through my employer I did have access to private insurance for which I paid via extra deductions from my pay slip. The idea behind private insurance, at least in the UK, is that you would use the NHS for emergency treatment or for chronic conditions. Private insurance is more for acute conditions where you wanted to avoid having to wait to be seen.
I have friends in Norway, and this is what their system looks like:
http://www.europe-cities.com/en/633/norway/health/
There seems to be constant debate/discussion in both the UK and the US about the quality of/access to care. But both countries are democracies (as is Norway), and the people of both countries are free to change their systems if they want. Both countries hear much the same arguments. In the US, we hear the rhetoric about the dangers of "socialized medicine" whereas in the UK, no politician would DARE propose to ditch the NHS. Indeed, I've heard British politicians declare they would never let a US-style healthcare system operate in the UK.
Like monrein has said, it does seem to me that the healthcare system in place in most places illustrates a prevailing underlying philosophy. The US values innovation and profit. Other systems reflect a value on universal access.
Hope this helps!
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Prime Timer, perhaps the words universal access are incorrect. My understanding is that the access to healthcare in your country is quite different for the insured versus the uninsured. I don't know. I live here and my focus is here. I'm very glad that you are happy with your system and your coverage. As I've stated before I feel extremely lucky to live where I do and to have what I have.
As far as non profit goes, it doesn't mean that doctors etc work for free, they are paid salaries of course and those are negotiated. Our doctors make less money than they would in the US and some leave for that reason and others stay and prefer not dealing with the insurance system of medecine. I'm not a doctor. I have had two careers, one as a university professor and a second as a social worker. Both times I was paid from tax payer money. both institutions were non profit, meaning that no private entity made money from my work. We do not have for profit dialysis centres.
I think you know where government money comes from...us, and of course we are not always happy with how it is spent.
Prime Timer, I'm sure we could have an interesting conversation in person but frankly I'm not that great a typist and I fully understand that you probably feel that the Canadian system is horrific. I speak only from my experience with this system and my appreciation for it.
All the best.
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Question: I wonder why the US has never had universal health care like Canada and the UK.
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Question: I wonder why the US has never had universal health care like Canada and the UK.
Because it would put many of the insurance companies out of business, or at the very least, cut into their profits. There is no denial of service here. If you are sick and need treatment, a doctor will treat you until there is nothing more that they can do. Sometimes the cost is questioned and needs approval, but that is incredibly rare. I can go to any hospital in the country in an emergency or outpatient basis and not be billed. I have also had dialysis in other centers with only a few days notice, again, at no cost to me.
I have said that the difference that I have found between my own dialysis center and the one I go to in the US is that when I go in here, they will ask how I am feeling. When I go in there, they ask how I'm paying.
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Question: I wonder why the US has never had universal health care like Canada and the UK.
Money. Google "Kent Thiry".
Also, history is a factor. This is a really, really interesting (non-political) article that outlines the history of our current system. I learned a lot from this!
http://www.post-gazette.com/healthypgh/2014/04/27/VITALS-How-did-U-S-employer-based-health-care-history-become-what-it-is-today/stories/201404150167
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Question: I wonder why the US has never had universal health care like Canada and the UK.
We've been trying since at least Theodore Roosevelt's administration (BTW, he was a republican). Canada instituted FULL single-payer health insurance back in the mid 1960's, right about the time we started Medicare. Canada's system doesn't allow any private health care, whereas Britain's system does (Britain's system has been around since the 1920's).
The reality however, is that , between everybody over 65 being eligible for Medicare, and for those low-income people being covered by MedicAid programs offered in each state, we already have 'socialized' health care for about 25-30% of the population. If you wanted to see how a single-payer system could work, just look at Medicare. In fact, medicare could easily be expanded from only covering those over 65 to covering everybody that didn't choose to buy/get private insurance.
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In fact, medicare could easily be expanded from only covering those over 65 to covering everybody that didn't choose to buy/get private insurance.
Not easily.
1. Medicare is a budget buster as is.
2. Expanding, at current premium/reimbursement rates, would be a huge increase in expenditure. Where is the $$ going to come from? Perhaps a nationals sales tax like the Canadian GST?
3. Providers tolerate medicare as a portion of their case load, because they can make their real profit on private prepay and insurance. I don't think the clinics could survive, and provide a return to investors, if they did all their treatments at $245 (medicare price). 100% Medicare, without significant changes, would significantly reduce the payments to service providers.
4. As soon as you introduce "everybody that didn't choose...." you are selecting a pool of higher than average risk customers.\
Like I said, "Not easily".
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Simon Dog, everything you posted above may be spot on; I don't know. But when I read "...provide a return to investors" in any post about the provision of access to health care/dialysis, it does give me pause.
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3. Providers tolerate medicare as a portion of their case load, because they can make their real profit on private prepay and insurance. I don't think the clinics could survive, and provide a return to investors, if they did all their treatments at $245 (medicare price). 100% Medicare, without significant changes, would significantly reduce the payments to service providers.
So my employer and it's insurance company subsidizes the Medicare patients at my facility and "provides a return to investors" for DaVita... I don't know why the insurance companies allow my facility to bill them $1550 per session versus the Medicare cost of say $245... Plus they bill separately for the lab work at $7 or so per lab.
I'm happy the we allow people in our country to receive dialysis regardless of the ability to pay. It also seems unlike say a hospitalization they find ways to pay for the rest with driving patients deep into debt.
The current system where we move costs and profits to private insurance doesn't seem right.
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Iolaire, I've always wondered the same. How do businesses/corporations allow themselves to underwrite Medicare via ever higher premiums demanded by insurance companies?
I would love to know which insurance companies provide health insurance for, say, Apple or Exxon or BP (maybe that would be Lloyd's of London) and how much those corporations pay in premiums.
Anyone know?
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Iolaire, I've always wondered the same. How do businesses/corporations allow themselves to underwrite Medicare via ever higher premiums demanded by insurance companies?
I would love to know which insurance companies provide health insurance for, say, Apple or Exxon or BP (maybe that would be Lloyd's of London) and how much those corporations pay in premiums.
Anyone know?
These days many companies show employees the breakdown of what the employee pays for health insurance and how much the company contributes. They want the employee to know the value of what they receive since its almost a non-tangible benefit. So most employees should be able to find it. My single person insurance plan including both contributions is about 1/3 of the following number. (My wife has her own insurance via her employer, she pays more).
Here is a quote on family insurance:
http://kff.org/health-costs/report/2014-employer-health-benefits-survey/
Annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, with workers on average paying $4,823 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2014 Employer Health Benefits Survey.
However many larger employer plans have some level of self insurance so I don't know how that effects the number reported to the employee. For example the famous case of the CEO talking about how some sick baby's hurt their profits.
http://fortune.com/2014/02/12/why-aol-ended-up-spending-millions-on-distressed-babies/
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don't know why the insurance companies allow my facility to bill them $1550 per session versus the Medicare cost of say $245...
Ask "why does a dog lick his balls" and you will have your answer - because they can. Insurance companies need to provide a certain range of services or they won't stay in business; dialysis providers need these cash cow patients; and the result of negotiation can vary widely. My company paid $445 until I was on medicare, but paid DaVita $10,100 for two out of town treatment since they had no negotiated deal.
But when I read "...provide a return to investors" in any post about the provision of access to health care/dialysis, it does give me pause.
The distinction between profit and non-profit only refers to stockholders. Non-profits often have very generously compensated executives (the PanMA challenge - a Massachusetts cancer charity - pays its founder over $500K/year; Ditto for the Susan Komen breast cancer foundation; there are many more examples). Plus the staff, docs, and most importantly, senior executives, in non-profits expect to be compensated at levels comparable to at profit facilities.
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quote:"1. Medicare is a budget buster as is."
Not really. The rates that Medicare reimburses for medical care, if used for all health care, would cost us just a bit over 9% of GDP, whereas today, we spend nearly 12% of our GDP on just health care. Canadians spend 9%, Britains spend closer to 10%, and the French, even with their lavish health care system spend only 11%. We are paying more than anybody else, yet getting less (and sometimes, getting not enough or even nothing).
Of course, if we did choose to have single-payer, we would need something like the Canadian GST to pay for it, or else a new income tax of some sort. You can't get something for nothing, you know. But, OTOH, you wouldn't be paying often $100/week/person for health insurance, either. Most people pay less than 50% out-of-pocket for their health insurance, but their employer pays more than 50%. Employers would LOVE to be free of handling this expense.
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Not really. The rates that Medicare reimburses for medical care, if used for all health care, would cost us just a bit over 9% of GDP, whereas today, we spend nearly 12% of our GDP on just health care.
Assuming your figures are accurate (and they probably are) - my comment was that changing to single payer would not be easy.
Cutting recipients of 3% of the GDP off from their cash cow would have major repercussions, especially when many in that population (insurance companies) are well represented by attorneys, lobbyists and payoffs (er, I mean campaign donations).
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Cutting recipients of 3% of the GDP off from their cash cow would have major repercussions, especially when many in that population (insurance companies) are well represented by attorneys, lobbyists and payoffs (er, I mean campaign donations).
And there you have it in a proverbial nutshell. And you are right that changing our current system would not be easy.
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The distinction between profit and non-profit only refers to stockholders. Non-profits often have very generously compensated executives (the PanMA challenge - a Massachusetts cancer charity - pays its founder over $500K/year; Ditto for the Susan Komen breast cancer foundation; there are many more examples). Plus the staff, docs, and most importantly, senior executives, in non-profits expect to be compensated at levels comparable to at profit facilities.
Oh believe me, I realize that! But I still am put off by the idea of stockholders profiting off of patients' maladies. That said, I do understand that my own investment portfolio is made up of companies like, say, Baxter, and the same can probably be said of anyone with a 401(K), but I still don't like the idea. But then AGAIN, I myself have a "malady", so I'll choose to believe that my own hypocrisy isn't TOO wicked. :P
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Good to see so many people on here discussing this and from all different angles. Health care obviously plays a key role in our lives.
A lot of doctors here in the US have stopped taking new patients who are on the government plan called "Medicare" and if they do take them, they want proof of supplemental insurance. My guess, is it's because the government (Medicare) is slow at paying doctors and when they do pay, it's not the full amount. Meanwhile, doctors have lives like the rest of us do; homes, food, children, etc to pay for AND...overhead to keep their clinics open. However, if it were ALL paid for (the doctor, clinic, staff, supplies, equipment and treatment, etc) by the government via taxes collected, that might solve the problem. Or does it? With so many people coming into the country (and world for that matter) and people living longer, I don't think there would be enough "tax payers" to collect from without sacrificing something. And that "something" probably would amount to level of care or rather, how much care/treatment the government could afford to dole out to equally cover every individual. That not only should cause some concern but personally, I don't think I want to give the government that much control. In other words, when I look at the "big picture", I think the issue of "universal" health care cannot be thought of without also wondering/worrying about loss of freedom...and not just when it comes to choosing a doctor...and how much in taxes would be enough?
Seems I remember a few years back over in the UK, young people and students rioted and looted stores (which unfortunately were no doubt owned by hardworking people/taxpayers), over their government mentioning the possibility of not paying or not paying as much for student college tuition anymore. Or maybe they were bringing up austerity measures. Anyway, one young lady stands out in my mind...as she was stealing a TV from a store, a news reporter asked her why she was stealing the TV....her reply was "to take back my taxes!" Seemed she was a bit angry over the idea of being taxed but then possibly not getting what she felt entitled to in return. Whew-wee! Could you imagine???
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Large companies don't buy health insurance the same way you and I do. They are self-insured, meaning costs come out of the company's expense budget. They hire an insurance company to be the administrator for their plan. They work with the plan administrator to set the rules for the plan. You will probably not find any two large companies with the same rules for their plan - covered procedures, copays, doctors, etc. You can google it to learn more but it's pretty common once a company has a few thousand employees.
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quote:"Cutting recipients of 3% of the GDP off from their cash cow would have major repercussions, especially when many in that population (insurance companies) are well represented by attorneys, lobbyists and payoffs (er, I mean campaign donations)."
Yes, but if they gave the insurance companies the paid responsibility to MANAGE the expanded Medicare (in much the same way they use insurance companies to manage federal flood insurance), both sides could win, and profits could still be made. They do something like this in Germany, and it's pretty efficient. Of course, the LAWYERS would be the main losers. Poor, poor attorneys, I guess. My heart just bleeds for them...
quote:"A lot of doctors here in the US have stopped taking new patients who are on the government plan called "Medicare" and if they do take them, they want proof of supplemental insurance.
A few, yes, but a lot? Not from what I've seen. All my doctors, hospitals, dialysis clinics, and specialists I've seen in the last 5 years take Medicare (I should know, because I manage my elderly father's medical care, as well as my own). There have always been a small percentage of doctors who refuse to deal with social-medicine insurance companies-doctors like those infamous plastic surgeons to the rich and famous. Even England has a few doctors who don't accept National Health insurance. It could change for the worse, but really, if instead of 30% of your potential customer group having medicare, it was more like 75%, how many doctors then would refuse it? Probably a LOT fewer...
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If Medicare is so bad for doctors and hospitals why are there so many ads in Florida for Medicare patients. Realize that the billing rates are inflated.
Medicare pays a little over 270 dollars for the Dialysis at the center I use. My insurance company pays a little over 1400 for the same treatment. If yo are uninsured the bill is 4500. There are small profits built into the Medcare payment. They make out like bandits on the private insurance companies. And the Uninsured, there payment is set so if they don't pay they become a tax deduction and its worth about 1500 after taxes. Usually companies feel Medicare patients pay overhead and the private insured or uninsured generate the obscene profits.
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Large companies don't buy health insurance the same way you and I do. They are self-insured, meaning costs come out of the company's expense budget. They hire an insurance company to be the administrator for their plan. They work with the plan administrator to set the rules for the plan. You will probably not find any two large companies with the same rules for their plan - covered procedures, copays, doctors, etc. You can google it to learn more but it's pretty common once a company has a few thousand employees.
Yes, but I wonder who these hired insurance companies are. I'm just curious, that's all. I'm just curious to know who, say, Exxon has underwriting their employees' health coverage.
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Large companies don't buy health insurance the same way you and I do. They are self-insured, meaning costs come out of the company's expense budget. They hire an insurance company to be the administrator for their plan. They work with the plan administrator to set the rules for the plan. You will probably not find any two large companies with the same rules for their plan - covered procedures, copays, doctors, etc. You can google it to learn more but it's pretty common once a company has a few thousand employees.
Yes, but I wonder who these hired insurance companies are. I'm just curious, that's all. I'm just curious to know who, say, Exxon has underwriting their employees' health coverage.
This talks a bit about those companies and how much AOL pays them. In that case its United Heath Care or Empire Blue Cross PPO maybe managed or bought via CIGNA.
http://fortune.com/2014/02/12/why-aol-ended-up-spending-millions-on-distressed-babies/
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Good to see so many people on here discussing this and from all different angles. Health care obviously plays a key role in our lives.
A lot of doctors here in the US have stopped taking new patients who are on the government plan called "Medicare" and if they do take them, they want proof of supplemental insurance. My guess, is it's because the government (Medicare) is slow at paying doctors and when they do pay, it's not the full amount. Meanwhile, doctors have lives like the rest of us do; homes, food, children, etc to pay for AND...overhead to keep their clinics open. However, if it were ALL paid for (the doctor, clinic, staff, supplies, equipment and treatment, etc) by the government via taxes collected, that might solve the problem. Or does it? With so many people coming into the country (and world for that matter) and people living longer, I don't think there would be enough "tax payers" to collect from without sacrificing something. And that "something" probably would amount to level of care or rather, how much care/treatment the government could afford to dole out to equally cover every individual. That not only should cause some concern but personally, I don't think I want to give the government that much control. In other words, when I look at the "big picture", I think the issue of "universal" health care cannot be thought of without also wondering/worrying about loss of freedom...and not just when it comes to choosing a doctor...and how much in taxes would be enough?
I have heard people say that "government controlled healthcare leads to a loss of freedom". I hope those people realize that having private insurance also leads to a loss of "freedom".
From just my personal experience, I can tell you that I have private insurance via my husband's employer, and I have experienced a loss of freedom because before I can see a specialist of any kind, I have to have the permission of the insurance company. I can choose a PCP only from a list of PCPs, and to see a specialist, I first have to see a PCP and request a referral. I am right now awaiting a referral from my PCP for my annual post tx appointment that is only 2 weeks away. I submitted my request, IN WRITING, 3 weeks ago and I have yet to hear anything. I will now have to spend time chasing people up. Having private insurance has not benefitted me in this regard
As for slow payment to healthcare providers, well, I had my annual post tx appointment last year at around this time, and it took about 6 months for them to receive payment because my PCP's business office and my insurance company failed to communicate with each other. I was caught in the middle, receiving statements/bills each month until finally I started getting phone calls and threats of having my account handed over to a collection agency. I can't tell you how stressful this was. I was ready to pay out of pocket but my husband refused to let me do this; he spent an inordinate amount of time on the phone, trying to get the PCP's office to coordinate with the insurance carrier AND the healthcare providers who wanted to be paid, and rightly so. It was a nightmare, and since I have my next appointment in just a couple of weeks, I'm really nervous that I'm going to have another 6 months of battling ahead of me.
In summary and in speaking only for myself, having private insurance has not given me more "freedom" and has not led to quicker payment to my healthcare providers.
To anyone who wants to explore possible alternative to how an insurance market in the US might look like, I PLEAD with you to read this:
http://www.upmc.com/about/why-upmc/changing-health-insurance-market/Documents/time-article-2015.pdf
Basically, this article by Stephen Brill offers the idea, which is actually already being implemented in some places here in the US, of having large networks of hospitals, clinics, etc become both healthcare providers AND healthcare INSURANCE providers. In this article, you can read about the Cleveland Clinic Model. The idea is to cut out the middlemen, the insurance companies, since their admin costs account for almost a quarter of private healthcare expenditures. Now, I'm sure the insurance industry lobbyists won't like that, but hey, if you want a free market, then you're going to have competition, and that competition looks more and more to be the hospital networks themselves. I know that in my neck of the woods, our local hospitals are now part of the Cleveland Clinic and/or Northwestern, so I can see the future from my house!
Seems I remember a few years back over in the UK, young people and students rioted and looted stores (which unfortunately were no doubt owned by hardworking people/taxpayers), over their government mentioning the possibility of not paying or not paying as much for student college tuition anymore. Or maybe they were bringing up austerity measures. Anyway, one young lady stands out in my mind...as she was stealing a TV from a store, a news reporter asked her why she was stealing the TV....her reply was "to take back my taxes!" Seemed she was a bit angry over the idea of being taxed but then possibly not getting what she felt entitled to in return. Whew-wee! Could you imagine???
I'm surprised that US students don't riot. Tuition in the US is rising faster than the rate of inflation, and the amount of collective debt from loans for tuition is scandalous. Most of us don't get what we want in return for the taxes we pay. Tuition in the UK is miniscule compared to that in the US. People steal during riots just because they can. I hope she enjoys her TV since now she will have to pay for a TV license! The BBC ain't free!
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Thanks for that, Iolaire! Very interesting. I confess that I'm not in the mood at the moment to do much googling, so thanks for doing the work for me!! :thumbup;
This article again makes me wonder why companies like AOL don't balk at having to provide health insurance. It just seems to be such a big extraneous expense. I guess they just accept that it is a cost of doing business and having employees in the US. It seems very anti-business to me, but no CEO is calling me to ask me my opinion!
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Thanks for that, Iolaire! Very interesting. I confess that I'm not in the mood at the moment to do much googling, so thanks for doing the work for me!! :thumbup;
This article again makes me wonder why companies like AOL don't balk at having to provide health insurance. It just seems to be such a big extraneous expense. I guess they just accept that it is a cost of doing business and having employees in the US. It seems very anti-business to me, but no CEO is calling me to ask me my opinion!
No problem, I have to assume that not only is my company allowing me to go to treatment, but they are directly paying for that treatment and someone in HR in a confidential role knows my cost to the company...
I think the company's are able to save money because they have some control of the program. For example if they were to promote healthy lifestyles within the company in the long run they might directly see savings in their cost of insurance.
Healthcare is a huge expense and companies must find this a method to control costs.
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If you read the sec filings of medical companies Medicare is not unprofitable. Most companies believe Medicare patients pay the overhead and private insurance provides the major profits. The whole payment system is designed to maximize profits. Personally at my clinic its 275 dollars for Medicare. Private insurance 1475 dollars. Uninsured 4500 dollars. The uninsured rate is set high enough that if unpaid the tax benefits would be high enough that it shelters the profits from the other patients. However Medicare is still profitable for the companies. The best proof is that hospitals in Florida advertise for Medicare patients. If it was such a money looser why would they advertise.
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Yes, but I wonder who these hired insurance companies are. I'm just curious, that's all. I'm just curious to know who, say, Exxon has underwriting their employees' health coverage.
Well, I can tell you that, for the Xerox corporation at least, they have Anthem Blue Cross/Blue Shield manage their health care plan.
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At least in Hi Tech companies the selection of a health care company is important since the techies will change companies if the benefit package is substandard. Companies care about total employee cost Benefits + salary + office( light heat computers etc). Health care is only a component and the real reasons for Big companies going to the big insurance carriers is that the insurance carriers negotiate lower fees with hospitals and drug companies.
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No problem, I have to assume that not only is my company allowing me to go to treatment, but they are directly paying for that treatment and someone in HR in a confidential role knows my cost to the company...
In traditional insurance plans, the insurance company pays in return for a premium.
Some larger companies (like the Extremely Massive Company I work for) self-insure, and do indeed pay for each bill. The employer is billed in aggregate, and not given any report of the cost of any individual employee (at least where I work) as no health information is shared with the employer.
The nice thing about the big company arrangement is that the P&L for the unit I work for is billed my premium as a cost, not the claims - so nobody who decides my fate will see my dialysis cost in the budget upon which they are evaluated.
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Quote:"As for slow payment to healthcare providers, well, I had my annual post tx appointment last year at around this time, and it took about 6 months for them to receive payment because my PCP's business office and my insurance company failed to communicate with each other. I was caught in the middle, receiving statements/bills each month until finally I started getting phone calls and threats of having my account handed over to a collection agency. I can't tell you how stressful this was. I was ready to pay out of pocket but my husband refused to let me do this; he spent an inordinate amount of time on the phone, trying to get the PCP's office to coordinate with the insurance carrier AND the healthcare providers who wanted to be paid, and rightly so. It was a nightmare, and since I have my next appointment in just a couple of weeks, I'm really nervous that I'm going to have another 6 months of battling ahead of me."
And yet, despite all the hooplah from those on the 'conservative' side of the spectrum about how great our profit-based system is, situations like this are pretty much the norm. I've been in just this same situation 4 or 5 times, between my own and my father's health care. In this situation, YOUR MONEY is being used to pay for all those billing agents, staff accountants, and yes, even collections agents who the insurance companies, doctors offices, and hospitals have hired to handle this (and every other billing issue that is mired in confusion). How on earth can we consider THIS to be "better"?
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If a person has insurance through an employer or as part of a group, you have a better chance of having fewer problems with the US system.
Ten years ago, I moved back to the US from the UK. The first thing I did was buy an individual, one year health insurance policy. I bought it through the (insert name of big ins. co. here) agent that my parents had used for years for their home/auto insurance. I suspect he didn't quite understand the product he sold me.
I was a reinsurance broker for underwriters at Lloyd's of London, so I know how to read an insurance policy. I read the binder backwards and forwards.
During that policy year, I had to make a few claims, nothing major. But 11 1/2 months in (ie, 2 weeks before expiry), I ended up in the hospital with a mysterious infection. I was in for a week. Despite being almost delirious, I knew that my policy was about to expire, so I had my fiancé arrange renewal. THAT's how important I knew it was to have private health insurance in the US.
Once I was home, I began getting bills from various healthcare providers. All of these had been submitted to the insurance company, but they just ignored them. I kept getting notices and phone calls from the hospital. I'd call the insurance company who said they'd "investigate". I had been in the hospital in August, and the following March I got a huge package of denied claims. The ins. co. had denied every single claim I'd submitted including the $20,000 I'd accrued while in hospital, most of them for "pre-existing condition" which was simply a lie.
I went through their appeals process, but they stonewalled me again. They they RETROACTIVELY CANCELLED MY POLICY! They sent me a check to cover the premium that I'd paid, but I did not cash it. I had to contact the Texas State Insurance Board, and THEY told the ins. co. to reinstate my policy, which they did but did not guarantee payment.
At one point, the ins co demanded that I submit my visa to prove that I was a legal US resident. They'd just made up some crap that I was here illegally. Well, I'm a US citizen, so...
I finally had to just sue them. I won a shedload of money, the maximum compensation legally allowed. PLUS they had to pay the maximum punitive amount for breaking a legal contract. Their OWN LAWYER said he didn't understand why they just didn't pay the claims.
Remember, this is a private insurance company that just decided on a hunch that I wouldn't fight back and randomly picked me to hassle. Again, I did not benefit from the "free market". Remember that any private company is going to seek to maximize profits (premiums) and slash costs (claims).
But here's the clincher. I was by this time on first name terms with the accounts dept at the hospital. Once my case was settled, I waited to get some sort of statement from the hospital/various providers to make sure that my account was clear. Nothing. So a few months later, I called the hospital to find out if they'd been paid. Remember, my final bill was $20k. Yes, the hospital said, my account had been settled for $7K. OMG! What was to happen to that other $13k?
So when people start talking about "freedom" and "choice" and the "market economy", well, I am proof that these don't always work in favor of sick people.
But I made a lot of money out of it! The ins co thought I was some sick lady, on her own in a new country, and they targeted me. They didn't know that I had experience in arranging insurance in the London and Scandinavian markets for some of the biggest manmade structures on earth. I literally laughed all the way to el banco. :rofl;
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I admit, I haven't researched this but do the Canadians/Europeans universal health care plans pay for their dialysis treatments when they travel abroad outside their country? Or what about if they want to live part of the year in another country?
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I have to say, I am lucky when it comes to the various health plans I've had over the years both with my current job of almost 8 years, and my previous job of over 7. I never had to wait around for a referral to a specialist. Not to say I never had a referral, but it was not a requirement. I have no problem making an appt with my regular neph or transplant team, thank goodness! I guess it's because we have PPO plans and not HMO? I even saw a gynocologist for a uterine ablation over a year and a half ago with no problem. My new plan, which is through my union, has a deductable, which is new to me, so I'm still learning the ropes on that. My Medicare ended at the end of November, so I was cushioned from it before because of that. I know my current situation won't last forever, but I am sooooo thankful for it while I have it!
I also have been lucky in having a wide range of dr's/hosptals/networks to choose from in my area that are "in network". I shall see how long that lasts...
KarenInWA
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Our insurance plan here in Ontario will reimburse a dialysis patient $210 per session (that is the rough equivalent of what a session costs the province) for out of country dialysis and the Kidney Foundation will provide a loan for up to six treatments until reimbursement money comes through.
It has been a long time since I traveled while on dialysis but I did so a couple of times to Massachusetts and to Florida. Some excellent and some atrocious experiences with this depending on the facility in question.
With my transplants I have traveled a fair bit and I currently spend a month in France every year. I would never travel without supplementary private insurance coverage and I choose an insurer that will cover me with full knowledge of all my medical history and issues. I answer all their questions and make sure that transplant is not considered a pre-existing condition that would cause me to be uninsured should something happen. I personally have no desire to travel and put myself at risk if I'm not medically stable and so far I've had no problems.
What I particularly appreciate about the system here is that I never have to deal with paperwork and payment. This is particularly important to me when I'm sick.
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Thanks for replying monrein and KarenInWA. I don't think I'd want to have to take out a loan to travel (unless I knew I really had the money saved up or knew I could pay it back) but I'm guessing with that system, some sort of payment plan is agreed upon that is affordable to each individual. As for HMO's and PPO's here in the States, employees are paying more towards their premiums AND deductables than we use to pay. Employers use to pay a bigger percentage of the premiums but as their costs of doing business have increased, a bigger portion has been passed on now to the employee and we've also seen an increase in deductables -and that's in addition to the increases in taxes separate from health care that employees and employers are paying, along with seeing our dollar devalued. What I like about plans offered by an employer, is that I can call up my doctor today and probably be seen today, if not tomorrow and for any reason (whether I have a sore throat or a fever or aching elbow or even if I just feel out of sorts. Unless it is after hours and an extreme life-threatening emergency, we don't have to go to the hospital, where one can end up waiting for hours on end to be seen as staff performs triage to decide who is seen first.
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PrimeTimer, when I lived in the UK, I could usually see my GP the same day if I needed to. I can't say the same about seeing my PCP here in the States, but then again he is part of a larger practice and services a larger pool of patients.
With both systems (and I can only speak about the UK), a lot depends upon where you live.
As for dialysis, again I can speak only about the UK, but if you are a British dialysis patient and want to holiday abroad, the NHS will pay for dialysis if and only if your destination is part of the EU and you have a valid European Health Insurance Card. To have that, you must be a UK citizen. I didn't qualify because even though I was a UK legal resident, I was not a citizen. So whenever I travelled, I bought my own insurance policy.
The NHS will most certainly NOT pay for any kind of medical care if you are on holiday in the US. Since most of my travel abroad was to the US, I bought a policy with a $10,000,000 limit. You do not want to either get sick or get sued in the US!!
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Resident of Ontario...my husband had one dialysis session in Las Vegas. It was $400 US and our provincial medical plan (OHIP) did reimburse us $210. I then submitted the remainder to my work insurance policy (it has 30 days out the country) to see if they would send us the difference. I haven't heard anything at this point.
Interestingly we have a trip scheduled to Minneapolis in May and we were trying to book a session there. The clinic we spoke to said $700 (which would be over $900 Canadian) so we decided against it and planned a shorter trip. The clinic called us back the next day and said "OK, $400 as long as we prepay." So we did.
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I think MooseMom is right. A lot depends on where you live in each country. In the more rural areas, the choices of doctors are less. The waiting periods or the drives to dialysis or whatever might be a lot longer in the boonies. In the cities, more doctors can mean more availability of care.
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In the UK I can have 26 session abroad with the NHS paying for it, if they have signed an aggreement, or are in the EU
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I have a great family doctor who most often will see me the same day. She also calls me at home and at the hospital and has a good working relationship with my transplant neph, whom she calls if she has concerns about my transplant. I also have yearly visits to my dermatologist, gynaecologist, bone density specialist every two years at this point and breast clinic every two years also. If I'm spiking a fever or other emergency situation I go to the ER of my hospital and that can be a long brutal experience or not depending on volume and triage. I personally don't use our walk in or after hours clinics since I think that my history is too complicated and I avoid ER as much as possible unless told to go by the transplant team. I also have a voice mail system at my hospital through which I can consult with my transplant coordinator who will pass along concerns to my neph. I do blood work every three months at my hospital because I can see them right away through an Internet account and I will call my neph if I have concerns since I actually see them before the team does.
Our system only reimburses $ 210 because that's the cost here within a non profit system. The loan from the Kidney Foundation is more like an advance of money to the patient who can then reimburse it later when our plan (OHIP) reimburses the patient but there is no interest accrued.
The cost for dialysis here for out of country visitors is about $450 . I'm talking about the only clinic in downtown Toronto that caters to foreign visitors. Our clinics (usually in hospital) and self care centres (not in hospital) don't accept out of country visitors.
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Resident of Ontario...my husband had one dialysis session in Las Vegas. It was $400 US and our provincial medical plan (OHIP) did reimburse us $210. I then submitted the remainder to my work insurance policy (it has 30 days out the country) to see if they would send us the difference. I haven't heard anything at this point.
Well, I just got good news, my plan at work covered the rest of the cost 100%. So it ended up costing us nothing. This will make travel much more affordable :)
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The cost for dialysis here for out of country visitors is about $450 . I'm talking about the only clinic in downtown Toronto that caters to foreign visitors. Our clinics (usually in hospital) and self care centres (not in hospital) don't accept out of country visitors.
Please can you share the name of that center just incase I ever need it? (A few years ago we went on a hiking trip to Tobermory at the tip of the Bruce Peninsula in the summer and loved it.)
Thanks @monrein for the response
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http://www.dialysisservicesinc.ca
Here is the link to their website. I have never used their services but one of the male nurses, a very nice guy, at the self care clinic I was at six years ago worked there and seemed to think it provided good service. I would be curious to hear about anyone who has first hand experienced with them.