Why We Need a Public Health-Care Plan

[Mr. Big Dog 10,747]

Running tests or performing proceedures does not = good health. Most Dr's will tell you that they perform more tests than is necessary because they fear litigation. They will also tell you that the red tape costs are down to having to ask the insurance for permission at every turn. That is a very, very costly exercise. If Doctors had the freedom to perform tests when they were deemed medically necessary without having to ask permission and people had the good sense not to sue except when something was egregious then the system might be cheaper. Until then, it's extremely wasteful and expensive, whether you 'buy' the arguments or not.

There are many degrees of "medically necessary" and well, somebody ought to control how

many tests doctors perform because tests costs money.

If not the insurance company, then it will be the government, but somebody WILL do it, you

better believe it.

Part of the issue is the fee-for-service compensation. More procedures = more $$$.

Simple math for the doc.

[Peikko 1,575]

Running tests or performing proceedures does not = good health. Most Dr's will tell you that they perform more tests than is necessary because they fear litigation. They will also tell you that the red tape costs are down to having to ask the insurance for permission at every turn. That is a very, very costly exercise. If Doctors had the freedom to perform tests when they were deemed medically necessary without having to ask permission and people had the good sense not to sue except when something was egregious then the system might be cheaper. Until then, it's extremely wasteful and expensive, whether you 'buy' the arguments or not.

There are many degrees of "medically necessary" and well, somebody ought to control how

many tests doctors perform because tests costs money.

If not the insurance company, then it will be the government, but somebody WILL do it, you

better believe it.

I thought you wanted as many tests as possible because that's one of the measures of an excellent medical system? My head is spinning.

The ideal is being able to have trust that the Dr who sees us from cradle to grave (or has access to all our records so that they know, exactly, our medical history) has the good sense, knowledge and medical acumen to order the tests that are necessary and not those we might think a good idea because we saw it on the telly.

Edited June 25, 2009 by Madame Cleo

[mawilson 2,133]

The ideal is being able to have trust that the Dr who sees us from cradle to grave (or has access to all our records so that they know, exactly, our medical history) has the good sense, knowledge and medical acumen to order the tests that are necessary and not those we might think a good idea because we saw it on the telly.

What are you, some kind of starry-eyed idealist?

[Trumplestiltskin 5,791]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

[Peikko 1,575]

The ideal is being able to have trust that the Dr who sees us from cradle to grave (or has access to all our records so that they know, exactly, our medical history) has the good sense, knowledge and medical acumen to order the tests that are necessary and not those we might think a good idea because we saw it on the telly.

What are you, some kind of starry-eyed idealist?

I know what I want. I just don't always know how to get it.

[Niels Bohr 72]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

[Mr. Big Dog 10,747]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

I always think it's somewhat funny when the scare squad complains that they want the doctor and patient - not a Washington bureaucrat - to make their health care decisions. They completely turn a blind eye to the fact that health care decisions aren't really made by doc and patient today but rather by some profit driven insurance bureaucrat. Oh, all that shallow propaganda.

[Ban Hammer 13,657]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

I always think it's somewhat funny when the scare squad complains that they want the doctor and patient - not a Washington bureaucrat - to make their health care decisions. They completely turn a blind eye to the fact that health care decisions aren't really made by doc and patient today but rather by some profit driven insurance bureaucrat. Oh, all that shallow propaganda.

at least the profit driven insurance bureacrat does not have to take into account denying something will help balance social security.

[scandal 951]

It all depends on your work place, how many dependents you have and what your workplace has negotiated with the insurance company.

I haven't lived in Canada since 1997, things may have changed in the past 12 years.

When I did live there, I had OHIP (the provincial health plan).

And I had through my employer, supplemental insurance for dental, and for vision care (eyeglasses, contacts), and short and long term disability plans. I don't remember paying any premiums for these, I seem to recall that they were 100% paid by my employer (Nortel). I could be wrong, and paid a small amount out of my paycheck.

OHIP covered all prescription medications. All hospitalizations. All doctor visits.

I had two children born in Canada - all prenatal care, postnatal care, immuniziations - covered by OHIP.

Caesarian sections, epidurals, covered by OHIP.

Usage of the hospital's birthing center and semi-private room - covered by a supplemental plan through Nortel, if I recall correctly.

My kids had routine ear infections, late night fevers.... all emergency room visits, scrips for antibiotics - covered by OHIP.

My wife at the time (now the EX) had a baffling condition over many months involving intense headaches, bright flashing light in her eyes, and other symptoms. She contracted Bells Palsy and lost the hearing in one ear. We never figured out exactly what happened and what caused all the symptoms, but she went through various diagnostic tests including MRIs and was seen by about 5 or 6 different doctors. All covered by OHIP.

She was unable to work for those months - covered by the short term disability at work, including an attending nursing aide who came to our home.

Okay, Weird. I wrote quite a massive response to this and...it disappeared after I posted it.

So here we go again.

I have never been 100% covered by OHIP, and I lived in Canada all my life until I moved to the US.

My dad had Sunlife and still does. They still don't pay 100% of anything. I always had to have supplemental insurance. I believe when we were growing my dad paid $400 to $600/month for a family of five.

My mum has gotten extensive dental work done and they have had to pay out of pocket many times for parts of it. This is also not cosmetic, it's stuff like crowns, bridges, and other dental repairs.

Before I left for the US I quit my job and had no supplemental insurance. I got strep throat and had to pay $17.00 for my medication, even though I still had OHIP.

So I'm guessing you got lucky with Nortel where they pad for 100% of everything for you. Not all insurance companies in Canada do that. It depends on what kind of plan is negotiated through your place of work and you usually pay out of your pay check per dependent.

Sorry you lost your long post. I really hate when that happens!

Tip: when I remember to do so, I'll do Ctrl-A, Ctrl-C to copy the entire text into the cut/paste buffer before hitting "Add Reply". That way if it somehow gets munched, I can just recreate it with Ctrl-V. I don't always do that, but after being burned a few times I try to, for essay-length posts.

I agree that dental is definitely not covered in Canada (under OHIP or other provincial plans). I don't believe it's covered under any nation's medical insurance (well, can't speak for generous European plans etc.). It's also not under discussion in the US, as far as I am aware.

I should point out that prescription medicines in Canada did require a modest copay at the pharmacy. And I think towards the end of our residence there (around 1996-1997) they introduced a copay for doctor's visits, maybe $5 or $10. I know it wasn't the case when my oldest son was born in 1992, but I do seem to recall it in 1996 when the second was born. I don't think there's anything wrong with a copay, there should be some minor barrier to prevent people from going to the doctor for every little sniffle.

[Mr. Big Dog 10,747]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

I always think it's somewhat funny when the scare squad complains that they want the doctor and patient - not a Washington bureaucrat - to make their health care decisions. They completely turn a blind eye to the fact that health care decisions aren't really made by doc and patient today but rather by some profit driven insurance bureaucrat. Oh, all that shallow propaganda.

at least the profit driven insurance bureacrat does not have to take into account denying something will help balance social security.

What?

[SaadBell 0]

The bottom line is do you want someone profiting on your health? If anyone who served in the military you got universal health care, and regardless of what you think, I for one always felt at ease knowing if my daughter of I got sick, we were covered. When they could not handle my illness when I got really sick, they sent me out and paid. Our military is run by the government and I don't see anyone asking to privatize this, and all the billions we spend on weapons to kill millions. But we like killing, just don't want to handle caring for our own.

[mawilson 2,133]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

I always think it's somewhat funny when the scare squad complains that they want the doctor and patient - not a Washington bureaucrat - to make their health care decisions. They completely turn a blind eye to the fact that health care decisions aren't really made by doc and patient today but rather by some profit driven insurance bureaucrat. Oh, all that shallow propaganda.

at least the profit driven insurance bureacrat does not have to take into account denying something will help balance social security.

What?

Charles is saying that the government has a conflict of interest in running these two programs (Healthcare

and Social Security), because the solvency of Social Security is undermined by increases in life expectancy

brought about by improved public health levels - people who live longer will receive more total Social Security

payments over the course of their lifetimes.

[Ban Hammer 13,657]

Its not necessarily that the doctor orders the wrong tests but that the insurance company can often overrule them on what they think is necessary or are willing to pay for.

Yes! Definitely true! A friend of mine, Vietnamese Medical Doctor (surgeon), is pursuing a Law degree so she can change the laws for HMOs and other rules regarding referrals, tests, etc...

She was a surgeon for 7 years. She despised the fact that it is a big issue to the insurance company for overruling their decisions.

I always think it's somewhat funny when the scare squad complains that they want the doctor and patient - not a Washington bureaucrat - to make their health care decisions. They completely turn a blind eye to the fact that health care decisions aren't really made by doc and patient today but rather by some profit driven insurance bureaucrat. Oh, all that shallow propaganda.

at least the profit driven insurance bureacrat does not have to take into account denying something will help balance social security.

What?

Charles is saying that the government has a conflict of interest in running these two programs (Healthcare

and Social Security), because the solvency of Social Security is undermined by increases in life expectancy

brought about by improved public health levels - people who live longer will receive more total Social Security

payments over the course of their lifetimes.

[mRx 16]

I'm still astounded how the majority of Americans believe that "more bureaucracy" is the right answer to this problem, and that somehow, the presence of a government insurance plan will somehow force private insurance to provide reasonable coverage. At least that's what I gotoutta the public plan TV ad.

Blaming high private insurance premiums for all our problems is analogous to blaming your thermometer for the temperature outside.

If the government really wanted you to have affordable healthcare, then they would eradicate all the artificial barriers to entry legislatively imposed on the healthcare industry.

[Usui Takumi 1,562]

Addressing private health insurance is only fighting half the battle. Part of the reason why healthcare is more expensive in the USA is because liability insurance is more expensive. With every drug you take and every visit to the doctor your subsidizing their very very expensive liability insurance. Why is the liability insurance so high? Because legal actions are often and expensive. I honestly believe that unless the government regulates payouts then the costs won't change. If malpractice is proven and death occurs we should be thinking values = to average life insurance not $xx,xxx,xxx.

By the way I find it somewhat ironic regarding myself. When I lived in the UK I was paying about £140 a month to the NHS (I was 25 when I left). I was making £21,000. In the US I pay nothing and I make about $50,500 (27 now) though no raise in two years because of economy.

I'm American , so I never knew if 21,000 was very good or not (I moved to the UK when I was 22) but I felt like I was paying alot for health. Now you must realize that I fit into the average insurable category when I mention this and arguably the NHS helps the uninsurable where the US will not. I just found it very interesting. (I do realize I'm very lucky that my employers covers all of my insurance including the premium..at least normally....at the moment due to the economy I pay it at about 90 usd a month still very much less then I was paying in the UK)