Why don't we hire Canada to take our extra heath care patients?

Of course the US would save lots of money. What’s in it for Canada, though?

By the way, outstanding article in the 1 June “The New Yorker” about the cost of health care in the US (and won’t put you to sleep at the same time): The Cost Conundrum

And it compares costs within the US, not the apples/oranges argument you get with comparing US to Canada.

“Interesting” idea, but I’d rather see us stop falling for the defeatist propaganda that we’re incapable of working collectively to solve our own problems. We’ve been told so often and so stridently that only the private sector can be relied upon to get things done (told, that is, by those who stand to profit from the private sector), that we’ve started to accept this as a law of nature. Bullshit. Plenty of other countries do it, and wouldn’t have it otherwise. Why are we so uniquely incapable?

Holy crap. Have you ever talked to a Canadian about their health care system are how it [doesn’t] works?

Many of them pay their own money to come here because to get something taken care of there “for free” could take weeks, months, or even sometimes years.

Better yet, why don’t we fix our own system? For being such a great country, it a shameful that our health care costs are the highest and our level of service is the worse when compared to other industrialzed countries.

Uh, we have enough troubles with our system WITHOUT the millions of you uninsured people. “We” don’t claim it’s great, I do claim it’s much better than the system you guys have set up. Our total population is less than your population without insurance, we’d be swamped if you came in. Plus we pay a lot of money in taxes that support this and other systems. You can’t just waltz in and take without paying.

You can learn from our system for sure, but you can’t just take it. Things don’t work that way :)

How did Americans get the idea that our healthcare system is so great?
we can’t cover Americans and canadians, we can barley cover the people we have.
I recently had a catscan that I wated two months to get… and that was just a catscan
Any medication you need isn’t covered unless you have health benefits(that you pay monthly for) either through your work or with a private company (even then it covers up to 80% of the price)

Canadians are already hiring doctors in the U.S. to take on their care when they can’t get it in Canada, so why not? ;) (sarcasm)

The thing is this. There is a limited amount of health care available in any given area (only so many doctors, hospital rooms, etc.) – and more people that need it than can get it. The difference is how a given area rations it out and decides who gets it. In the U.S., it’s rationed out by cost: people who can afford it get it, and people who cannot, go without. In Canada, it’s rationed by being in line (if I understand it correctly): those at the front of the queue (or pushed to the front of the queue) get it, those at the end, don’t.

Neither system is perfect. Both have strengths and weaknesses. But as long as there are more sick people than there is care available, something has to give.

@Harp: Part of the reason the “only the private sector can do it” rhetoric is so convincing is because the people pushing it, when they get into power, make government as incompetent as possible. Look at Bush, and how his appointee as head of FEMA botched the response to Katrina, for instance—that was intentional incompetence.

The biggest single problem with the U. S. system is that people without insurance and without money can’t get treatment at all, and if they do, it bankrupts them.

The biggest single problem with the Canadian system is that bureaucracy determines the speed and quantity of treatment.

People who are accustomed to the American system are aghast that Canadians cannot simply throw money at the problem without working outside the system (i.e., coming to the U.S. for treatment.) People who are accustomed to the Canadian system are aghast that people can simply be left on their own to suffer and die.

If you have money or health insurance or both, and no expensive or difficult conditions, the American system works pretty well. But there are millions of people who don’t have money or health insurance, and it doesn’t work well at all for them. At the same time, the Canadian system works reasonably well for everyone, but you can’t speed it up by throwing money at it.

The thing to look at, though, is where the health care money goes. How much of it gets frittered away in bureaucracy and administration? How much of it is spent on actual doctors, actual nurses, actual medicine? My sense is that quite a bit more of each dollar spent on American health care goes to middlemen and bureaucrats, and I think if we can address that—however we do it—we’ll improve the quality and quantity of American healthcare without increasing the costs.

This will probably mean that the shareholders at insurance companies will make less obscene profits, and the upper management of those insurance companies will probably see a reduction in their number or a cut in their salary or both. I don’t really have a problem with that.

I should probably ask this on the front page, but what are some examples where government intervention actually improved the efficiency or effectively reduced cost with the same level of options in any area?

Part of the problem that people point to with the current US system is that doctors are rewarded for sheer numbers, not quality of care. How do you think that came about? By government regulation, of course.

The problem I have with government bureaucracy is that it lacks any real mechanism to shift and meet the need of changing market forces.

I’m not necessarily opposed to gov’t regulation of crucial services, but I’d like to see more acknowledgement of where that bureaucracy is weak… and put mechanisms in place to accommodate it.

It seems like oft times, it’s just a free for all: “Government must intervene! Something must be done! Anything!”

And well, I think that’s just knee-jerk reactionism. Unfortunately, I don’t think the crop of politicians we have these days are capable of anything else.

@robmandu Actually, I did ask my Torontonian girlfriend how things were different when she got sick while visiting me in the US and we spent the whole day waiting in a clinic and then had to spend a ton of money.

She was quite clear about the quality of care there, and, having experienced both systems first-hand, I’d tend to believe her.

I’m all for changing this broken system so I never have to pay another $4K for going to the emergency room again. (And that was with insurance).

Okay, full disclosure: I live in the Netherlands (Holland) and the health care here is friggin GREAT. Low premiums, full coverage, world-class care and short-short waiting lists, if any at all. It’s a dream. It’s a good reason, as a US citizen, to continue to live and stay here.

To think that my son in California pays more for his health insurance than his mortgage?!!! Incredible.

@robmandu: it’s not government regulation that drives the number of patients that doctors must see to break even, it’s private sector regulation.

One real problem with private sector insurance is that it’s answerable to market forces—but the purchasers and consumers of its services are businesses, not the end users. If I don’t like the options that my employer offers for insurance, what can I realistically do about it?

@PapaLeo I was equally thrilled with the French health care system when I lived there. By contrast, I recently cut off the tip of my finger at work and walked to a hospital emergency room. I bled on their floor for 5 hours before they treated me. Here the emergency rooms are flooded with people who have no insurance and use the emergency room for primary care. This never would have happened in France.

@robmandu I had far more options under the French system, along with the much greater efficiency. Here, I have to use the insurer my employer offers (because I can’t afford anything else, of course). I have to choose from their list of approved providers (which changes all the time), and can’t go directly to a specialist, even when I know that’s where I’ll end up. In France, I could see any doctor I wanted, period.

And for all the supposed “choice” our system offers, the sizable uninsured segment of our population has next to no choice.

@Harp What’s ironic is that so many in the US paint socialized medicine as a bogeyman that would degrade services, limit choice, and force patients into a 1984-type system that treats them like automatrons. You and I have experienced “socialized” medicine as something far different.

What’s in a name?

Many people in the UK use German health care services.

@Harp, your choice here – as you describe it – is only limited by the fact that you’ve elected to keep using your company-provided healthcare.

You don’t have to. You can drop it… and that should provide a boost to your paycheck. You can take that money and put it into buying your insurance elsewhere. Can you get as good a deal as the bulk-rate your company has? Maybe. Maybe not.

But your choice certainly is not limited.

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Fyi: my company provides access to two healthcare plans. One is managed by the company itself. The other is BCBS. The benefits/limitations vary slightly… so we get to pick the one we want which makes the most sense for our current place in life. Or we can elect not to use it at all.

And don’t hate me because I’ve got it “so good”. I did my research in looking for a job. I checked out the benefits offered by various companies and made my choice of where to apply for work.

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Were I young, healthy, and single, perhaps having kickass healthcare wouldn’t matter so much. I could elect to keep my money even… or just buy health insurance to cover catastrophic situations.

I’m seriously worried that government-mandated healthcare is going to remove many of the options that the majority of Americans currently enjoy.

@robmandu Government should only regulate things that nobody wants to buy. In other words it should regulate it’s self starting with the FED and making congress read the bills before it passes them.

@coffeenut I can get a catscan in days. I hope that you did not really need it. In the USA we pay more because we get more. The problem wuth our insurance is that the wrong people are paying. That is not really right. The wrong people get credit for paying for it and it is regulated. Why is regulation a problem. Some states require me to pay for pregnancy services. They also include in the insurance regular medical expenses that are not insurable. Anything that it is certain that a particular individual will have to pay for is uninsurable. So people are paying premiums for other people to write checks for them. That is a big waste in the day of the debit card.
Your insurance is none of your employers business and it should be made that way again.

If he finds that he can not get people to work in unhealthy places. Then he will just have to pay more to get them to do so or make the places healthy. Not keep using insurance savings paid by other employees to subsidize insurance for those doing unhealthy jobs.

@robmandu Leaving my employer-provided insurance is hardly a viable option (and I think that’s the case for most folks who are lucky enough to have such insurance at all). Individuals who buy insurance independently are put into an ad hoc pool which is then closed to new members. Unlike a pool that’s based on a place of business and has a flow of new people, this closed pool rapidly goes downhill from an actuarial perspective as its members age. Since the rates for any pool are based on its actuarial risk, the rates for these independent pools (which are exorbitant even from the beginning), skyrocket over time. This is why it’s an option of last resort only. It’s a “choice” only in the sense that the lifeboat on a cruise ship is a “choice”.

It’s great that you have coverage that you’re happy with through your work. Mine’s no worse than most out there, either. But I think it’s insane that health coverage is linked to where we work as it is in this country. Why the decision of where to work should be dictated by health care choices escapes me. Since we’re talking about choices here, under the French system, not only did I have completely free choice of doctors, but I had a completely free choice of employers since my coverage would not be affected as a result.

I agree that it would certainly be possible to screw things up big-time with a poorly-crafted national health care plan. But I also know first-hand that it’s possible to do it in a way that increases rather than decreases choice.

@Harp: you may want to take a look at the Massachusetts solution. It mandates that everyone must buy health insurance, but puts all otherwise uninsured people into one pool. When I was between jobs the last time, continuing COBRA coverage from my old job would have cost me nearly $800 a month, but identical coverage—same company, same limits, same deductible—through the Massachusetts state program cost me under $250 a month. Which was close to what my employer had been paying.

(Not that you’ll be able to benefit from it if you’re not in Massachusetts—but you might look and see an alternative system evolving. I don’t think we’re going to be able to go from our current system to a national socialized single-payer system—there’s simply too much resistance and too little political will—but I think we could get there if we work incrementally.)

It makes economic sense, too—small businesses are hamstrung by health insurance costs. I know a company that was formerly paying upwards of $7K a month for health insurance for 2 partners and 2 employees; when the Massachusetts plan went into effect, they cancelled insurance through work and gave everybody a $300 a month pay raise to compensate for them having to arrange for their own insurance. Everyone won—the company is happy because $1200 < $7000, the partners are happy because that takes some revenue pressure off the company, and the employees are happy because they have choice of health insurance plans—including cheap catastrophic plans if they’re otherwise healthy.

@Harp Are those pools mandated by regulation. That seems to be a peculiar way to do insurance. I would want my pools big so that I could give a good price to my customers. It is not insurance at all if everyone is certain to have problems.

What I mean is that insurance should be for the rare occurrence, not for what is certain to happen. If it is certain to happen it would be better to put the money into an escrow account.

The timing of insurable events is random but for certain things it can be calculated and provided for with a minimum of insurance.

I know I don’t know how the industry is currently structured. What I am trying to do is propose as to how it should be structured. With change it should be possible to make real changes.

@walterallenhaxton: Insurance companies don’t want to give a good price for their customers. They want to make as much revenue as possible and pay as little as possible out. They really can’t avoid negotiating with companies—who are their real customers—but if they tick off an individual insured person, what is that person really going to do? Go somewhere else? Not if they have anything that might remotely qualify as a preexisting condition.

@cwilbur So you don’t know how markets work.

Companies only work for their customers and their satisfaction is most important. The people treated by the employer paid health plan are unimportant to the insurance company. For the employer he has taken care of a chore for his employees. He does not care unless they start quiting on him.

For the people getting health care it is most important that they get good health care. If they were buying it themselves the insurance companies would do everything to make them happy. There are 1300 such companies in the USA. If the customers were free to shop only the best companies would get their business and they would have to provide the best service available or loose business.

@walterallenhaxton: I do, in fact, know how markets work.

The satisfaction of customers is not most important. The profit that goes to shareholders, and secondarily the earnings of top executives, are most important. The satisfaction of customers is only relevant insofar as it contributes to that bottom line.

And the insurance companies would still not do everything they could to make customers happy even if they were selling the insurance directly. An insurance company simply cannot afford to pay out $1000 a month in benefits to someone who’s paying $200 a month for the policy. With group plans they can afford it, because for every person who’s paying $200 a month and consuming $1000 in services, there are five or six people who are paying $200 a month and consuming no services.

You’ve bought into the libertoonian fallacy that the free market will fix everything. Just like the free market in mortgage-backed securities served us so well.

@cwilbur You don’t know anything about how insurance works either. It is all about large numbers of people in a category. You can’t insure just one person. That is silly. They have to take care of such things themselves. For it to be insurance it has to be group insurance. For example masons, carpenters or loggers insurance. The problem we keep having is that in employer based insurance the categories are all wrong and make no sense at all so proper pricing of risk can not be made.

Do you have any idea what the difference in cost is for students health insurance and truck Drivers health insurance? I don’t. But if I was shopping for it and it was figured by company I would still would not know. But if it was figured by occupation everybody would be able to find out. If some occupations cost too much they they would either loose people or have to pay more salary.

All insurance policies are by definition group policies. You are thinking of bonds. That is another subject.

Of course the market will not fix everything. It will not fix those things that the customers don’t want. It will not make possible the impossible. One thing it certainly can’t do is make a government turn a profit. A government can’t do that either.
Also it will not fix the coming great inflation. Only the FED raising the interest rates so high that it pays the banks to pay enough interest for people to save and raising the reserve requirements high enough to take back the money it has already put out there in the last year will do that.

An economy is made by producers. Not by consumers. By over consuming they use the wealth of the economy up and it will need to be replaced by producers.

You run your insurance company and screw the customer and I will run mine and give the customer the best customer service possible and may the best man get very rich. No government force involved. That is cheating the game and the customer.

@walterallanhaxton: Please refrain from telling me what I’m thinking of. It only makes you look like an idiot who’s attempting telepathy and failing.

You are aware that in Massachusetts health insurance companies are required to offer individual health insurance, which works by putting everyone in a group? (Apparently not, or you wouldn’t be telling me that I don’t understand how insurance works.)

You are aware that outside of Massachusetts, insurance companies charge exorbitant rates to individuals seeking health insurance, and will often refuse to insure people on the slightest pretext—sometimes even retroactively, after the premiums have been paid? (Apparently not, or you wouldn’t be telling me that I don’t understand how insurance works.)

You realize that with the current system, the health insurance company’s customer is not the person actually insured but the employer of that person, who really doesn’t care how good the health insurance is? Again, the satisfaction of the customer is only relevant insofar as it contributes to the bottom line.

One of us doesn’t understand how health insurance works, and it sure doesn’t appear to be me. Especially as you’re the one who noted, above, that you don’t know how the industry is currently structured.

All the libertoonian wingnut rants about the power of the free market won’t change that. The market works, insofar as it does, because people seek profit both personally and collectively, and with any sort of insurance that translates to charging the highest premium you can get away with and providing the cheapest services. And “the best customer service possible” is not cheap, unless you interpret “possible” to mean “compatible with paying as little as I can get away with,” in which case it’s not going to be very good customer service.

@cwilbur It looks a whole lot like you. I am talking about insurance and you are talking about the mess that exists now a days. It is hardly insurance and I agree with you on that if you will stop calling it insurance. It is a mess dictated by government. It could not exist in a free market. I never claimed to know or to want to know about the present system. I understand that it is to be abolished and therefore it is irrelevant to our discussion. You are also confused as to who the customers are under the current system. When the employer buys the insurance the employer is the customer and not any third party. Of course third parties don’t get good service. You don’t have to sell anything to them and they pay for nothing. They are just objects to be dealt with.

With a simple law abolishing all insurance regulation by any government we can fix the insurance mess.
As for the uninsurable the government already has programs for them. If there is a problem with them then the government can work on fixing their programs and leave everybody else alone.
The price of following all of the crazy laws would go away. So insurance prices would fall and shoppers would be able to buy insurance anywhere. That would squeeze the price gougers out. Of course the insurance companies would still be under our criminal laws and if they fraudulently sold insurance and refused to deliver they would have to go to court and prove their innocence of the parties responsible would have to pay and or go to jail and loose their license depending on what the jury says.

Since you have a name calling problem I am going to stop responding to you. Your behavior is juvenile.

I refer you to my quips here and here. If you seriously think I’m confused about who the customers of the insurance companies are, I can only conclude that you’re just not paying attention.

And yet again I find you in a question where you’re answering based not on what actually is and what is observable, but based on some fantasy you’ve got about the way you think things should be—and one that only works if you ignore economics altogether. That’s the principal difference between a libertoonian and a libertarian.