Question for Canadians/Europeans

[MooseMom]

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.

[MooseMom]

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. 

[PrimeTimer]

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???

[jeannea]

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.

[Alex C.]

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...

[Michael Murphy]

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.

[MooseMom]

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.

[iolaire]

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/

[MooseMom]

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!

[MooseMom]

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!!

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! 

[iolaire]

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!!

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.

[Michael Murphy]

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.

[Alex C.]

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.

[Michael Murphy]

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.

[Simon Dog]

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.

[Alex C.]

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"?

[MooseMom]

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. 

[PrimeTimer]

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?

[KarenInWA]

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

[monrein]

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.

[PrimeTimer]

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.   

[MooseMom]

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!! 

[justagirl2325]

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.

[jeannea]

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.

[cassandra]

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