Question for Canadians/Europeans

[iolaire]

...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... 
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.

[Simon Dog]

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?

[Alex C.]

"...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.

[Sugarlump]

...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... 
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

[iolaire]

...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... 
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.

[cassandra]

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. 

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

[PrimeTimer]

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

[Riki]

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.

[monrein]

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.

[PrimeTimer]

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?

[MooseMom]

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!

[monrein]

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.

[PrimeTimer]

Question: I wonder why the US has never had universal health care like Canada and the UK.

[Riki]

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.

[MooseMom]

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

[noahvale]

*

[Alex C.]

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.

[Simon Dog]

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".

[MooseMom]

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.

[iolaire]

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.

[MooseMom]

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?

[iolaire]

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/

[Simon Dog]

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.

[Alex C.]

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.

[Simon Dog]

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).