boymimbo
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March 30th, 2012 at 4:18:58 PM permalink
SooPoo, when you work in a health clinic just across the border from Canada, you are going to get a number of Canadians who are pissed off with the Canadian system. It's akin to working in a courthouse and assuming that everyone's a criminal. Your experience does not necessarily reflect the views of all or even most Canadians. Physicians want to come to the states as they make ALOT more there, and they are probably frustrated with some aspects of our service. Our doctor shortage is due to the wage differential. But there are plenty of doctors here who are perfectly content.

Admittedly, the Canadian system is frustrating FOR the wait times. This, by far, is the biggest complaint about our health system, and our various government agencies have worked to reduce wait times based on funding. There are benchmarks set by CIHI for procedures that provinces need to meet. It's a funding issue. I cringed when my dad was on the wait list for his surgeries. He was on crutches and in pain while waiting, and had I had the money, i might have jumped the queue and sent him stateside.

And I don't disagree that you don't turn anyone away for emergency care. It's the non-urgent and preventative care that doesn't happen because you don't have insurance or the deductible is ridiculously high. But if you're collecting 4 cents on the dollar for people who don't pay, where do you get the funding for them? The government, or by overcharging for insured services? How is that efficient?
----- You want the truth! You can't handle the truth!
Nareed
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March 30th, 2012 at 4:21:52 PM permalink
Quote: boymimbo

Admittedly, the Canadian system is frustrating FOR the wait times.



That is pretty big. If your doctor thinks you may have cancer, a wait of even a few days for diagnostic tests can be all the difference between remission and death.
Donald Trump is a fucking criminal
boymimbo
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March 30th, 2012 at 4:29:42 PM permalink
Our REALLY bad wait times are for non-critical issues.

For example, the wait time for heart bypass surgery is on average, 7 days. (from diagnosis to surgery).
The average wait time for radiation therapy is on average, 8 days (from ready to treat to treatment).
The average wait time for hip fractures - 25 hours.
CT Scans in my province - 7 days
MRIs in my province - 34 days (there's increased funding to reduce this across the country).
----- You want the truth! You can't handle the truth!
weaselman
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March 30th, 2012 at 4:36:56 PM permalink
Quote: EvenBob

A real doctor who actually deals with the real system.


With all due respect to SOOPOO and his opinion, the system is not for doctors, it is for the patients. An opinion of a "real patient who actually deals with the real system" (like boymimbo for example) should therefore have more weight.
It is not surprising to me at all, that a doctor prefers a BCBS patient to Medicare (or that a Canadian doctor prefers American system) - private insurance pays better and is easier (for the doc) to deal with. if the purpose of the health care reform was to make doctors happier and wealthier, this would settle the dispute (I don't mean to say that the doctors should be poor and unhappy, just that health care is about caring for patients, not for doctors).

Quote: boymimbo


MRIs in my province - 34 days (there's increased funding to reduce this across the country).


Last summer I had a bad case of radiculopathy. It took me exactly 6 weeks to get an MRI. Yes, it was in America, with its best health care system in the world. I was in pain the entire time.
"When two people always agree one of them is unnecessary"
Nareed
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March 30th, 2012 at 4:55:54 PM permalink
Quote: boymimbo

Our REALLY bad wait times are for non-critical issues.

For example, the wait time for heart bypass surgery is on average, 7 days. (from diagnosis to surgery).



Ok, averages are tricky things. Some people require near-emergency or emergency bypass surgery. others don't. Does this mean someone in critical condition can be treated at once, or that he will wait at least a day or two?

Quote:

CT Scans in my province - 7 days
MRIs in my province - 34 days (there's increased funding to reduce this across the country).



I'm not up to speed on the various kinds of scans available, but these two are used to find tumors. Waiting even a few days to find a tumor can be quite deadly.
Donald Trump is a fucking criminal
mickpk
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March 30th, 2012 at 4:56:31 PM permalink
Quote: EvenBob

A real doctor who actually deals with the real
system. Not pie in the sky liberals who think
gov't health care the answer. As I keep saying,
my sister law would be DEAD if she didn't come
here for treatment. And that seems just fine to
the Canadians.



Well, I've got a sample size of one, as well. We have an American friend living in Australia. Her family is still living in the US but one of the reasons her and her Australian husband are reluctant to move back to the US is our 'liberal', 'socialist', 'inefficient', 'unpopular', (and too many other adjectives to choose from) universal health care. For reasons unknown (duh, perhaps actual experience), they much prefer it than what they had previously experienced in the US. There's just no pleasing some people; happy with a run-down Yugo rather than a BMW.
EvenBob
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March 30th, 2012 at 5:40:44 PM permalink
Quote: boymimbo

Admittedly, the Canadian system is frustrating FOR the wait times. This, by far, is the biggest complaint about our health system



That and the little complaint about how they'll
let you DIE if they don't want to pay for your meds.
"It's not called gambling if the math is on your side."
SOOPOO
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March 30th, 2012 at 6:34:56 PM permalink
Quote: weaselman

With all due respect to SOOPOO and his opinion, the system is not for doctors, it is for the patients. An opinion of a "real patient who actually deals with the real system" (like boymimbo for example) should therefore have more weight.



Yikes, weasel! I take care of real patients! The canadian examples I gave you were real patients, who had life threatening emergencies that could not be taken care of in Canada, and were transferred here, of course not as quickly as they would have been taken care of if the Canadian doctors were available. And the lithotripsy example were real patients who were fed up with ridiculous waiting times and paid out of their own pocket to get appropriate 'American quality" care. And I can assure you, if the federal government expands its role in our health care system, there will be fewer and fewer doctors, taking care of more and more patients. The agony of filing a Medicaid bill for the pennies they pay is just not worth it....
And yes, there are many different ways physicians who provide care to the unuinsured are subsidized, either through subsidies directly from a hospital, relatively higher payments from insured patients, etc.. There would be no physicians who would take care of these unfortunate souls if they were not being compensated somehow.
weaselman
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March 30th, 2012 at 8:10:23 PM permalink
Quote: SOOPOO

Yikes, weasel! I take care of real patients!


I know, of course you do. I am just saying that your perspective is different from someone's dealing with the system as a consumer.

Quote:

The canadian examples I gave you were real patients, who had life threatening emergencies that could not be taken care of in Canada, and were transferred here, of course not as quickly as they would have been taken care of if the Canadian doctors were available.


You are not saying it never happens in US that a doctor isn't available, are you?
When my wife was giving birth to my daughter, they could not find an anesthesiologist to give her an epidural for more than seven hours. I know, giving birth is not the first priority for an anesthesiologist, but seven hours? What if there was a sudden complication, and she need an emergency operation, would they have to cut her with anesthesia? Or just take her on a helicopter to Canada?

When I had an appendicitis attack, I spent the whole night in the ER waiting for the surgeon. In the morning, when he still did not show up, and they could not wait any longer, they put me in an ambulance and drove for an hour to another hospital to have my surgery.

You happen to be next to the border with a friendly country, so, naturally, you get to see some Canadian patients who get sent to your hospital when they have shortage of resources. I was in the same exact situation as those patients, except I am not close to the border, so I was just sent to a different hospital in the same country. Still, it is clear that the same exact issue is present on both sides of the border.
I have more stories if this is not enough. For what its worth, I think, the problem with availability of medical resources in US is simply horrible. I don't know about Canada, sounds like it has it too, I am just telling you that we have nothing to be proud about in this respect.

Quote:

And the lithotripsy example were real patients who were fed up with ridiculous waiting times and paid out of their own pocket to get appropriate 'American quality" care.


Yes, that happens. I quoted some stats earlier. Apparently, about 70K people come to US from abroad to get medical care in a year. About 750K Americans seek to get medical care in other countries during the same period.
That is more than 10 times more people paying to get rid of "American quality" care than those who pay to get it.

Quote:


The agony of filing a Medicaid bill for the pennies they pay is just not worth it....


Well, either we have the worst government in the world, or the laziest doctors ... Somehow, this agony is worth it to doctors everywhere else but here.

Quote:

And yes, there are many different ways physicians who provide care to the unuinsured are subsidized, either through subsidies directly from a hospital, relatively higher payments from insured patients, etc.. There would be no physicians who would take care of these unfortunate souls if they were not being compensated somehow.


Of course. I am not saying they should not be compensated. To the contrary, the universal system is the way to ensure that the hospital (and the doctor) always gets compensated (in full) for their services, unlike the current situation when you guys much of the time end up working for free or making pennies on the dollar. When everyone is covered (by the government), yes, the standard "rate" you charge for a patient will likely have to go down somewhat (no more $150 charges for a five minute appointment, and an ibuprofen prescription), but on the flip side, every patient you see will pay in full.
"When two people always agree one of them is unnecessary"
EvenBob
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March 30th, 2012 at 8:27:06 PM permalink
Quote: weaselman

About 750K Americans seek to get medical care in other countries during the same period.



And the majority of those are elective procedures they can
get done cheaper in another country. You know what
elective surgery is? And a great deal of it is dental.

Big deal.
"It's not called gambling if the math is on your side."
weaselman
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March 30th, 2012 at 8:43:51 PM permalink
Quote: EvenBob

And the majority of those are elective procedures they can
get done cheaper in another country. You know what
elective surgery is? And a great deal of it is dental.

Big deal.



No, not dental, the studies were only about medical. Some are elective, some are not. They talk about heart bypass surgery and such.
Some are because of price, some aren't. I personally know a guy who went to Israel to get his cancer removed, because they would not do it here, said it was impossible. He had insurance here, had to pay out of pocket there ... but had no choice.

Either way, it does not matter. People, who come here, mostly do so for elective procedures too, so the comparison is fair.

The point remains - 10 times more people want to pay to not experience "the best health care in the world", then there are those who come here to get treated. It's just another myth.

Yes, I think it is a big deal, because it is a fair comparison of US health care system with the rest of the world. You guys should just drop the whole "best in the world" line, it is getting old.
"When two people always agree one of them is unnecessary"
SOOPOO
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March 31st, 2012 at 3:39:31 AM permalink
Quote: weaselman




You are not saying it never happens in US that a doctor isn't available, are you?
When my wife was giving birth to my daughter, they could not find an anesthesiologist to give her an epidural for more than seven hours. I know, giving birth is not the first priority for an anesthesiologist, but seven hours? What if there was a sudden complication, and she need an emergency operation, would they have to cut her with anesthesia? Or just take her on a helicopter to Canada?

When I had an appendicitis attack, I spent the whole night in the ER waiting for the surgeon. In the morning, when he still did not show up, and they could not wait any longer, they put me in an ambulance and drove for an hour to another hospital to have my surgery.

You happen to be next to the border with a friendly country, so, naturally, you get to see some Canadian patients who get sent to your hospital when they have shortage of resources. I was in the same exact situation as those patients, except I am not close to the border, so I was just sent to a different hospital in the same country. Still, it is clear that the same exact issue is present on both sides of the border.

When everyone is covered (by the government), yes, the standard "rate" you charge for a patient will likely have to go down somewhat (no more $150 charges for a five minute appointment, and an ibuprofen prescription), but on the flip side, every patient you see will pay in full.



In all the hospitals in Buffalo that do Obstetrics there is an anesthesiologist in house 24 hours a day for immediate epidural placement, with the legal requirement of a back up available within 30 minutes if a Csection is needed. I don't know where you live but I don't want to be there! The same can be said about your appendicitis fiasco. The ER calls the surgeon, and from time of diagnosis to the OR is usually an hour or two.
The 'rate we charge' issue is the most complex. I negotiate rates with all our local insurance companies, and after haggling we have always come to an agreement. I cannot negotiate with the government. They tell me what I can charge. As an anesthesiologist, Medicaid pays abot 13%, and Medicare about 27%, of what 'real' insurance pays. In the event of a 'one payor system', what level do you expect the government to select? The guess is they will 'offer' some small increase from Medicare, expecting the physicians to make maybe 40 -50% of what they do now. The instantaneous mass exodus (older docs who 'could' retire but still opt to work) of many of us will make the waits described here seem like immediate care! Additionally, the pipeline of young bright folks, who you WANT to be the doctors of the future, will dry up.
There is a reason people do the 4, 4, 4.. (After high school- 4 years of college, 4 years of Medical School, 4 years of Anesthesiology residency)- it's because we get compensated for it. And there is a reason you want it to be that way- you want a well trained doc at your side keeping you alive....
AZDuffman
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March 31st, 2012 at 5:58:07 AM permalink
Quote: weaselman


Yes. And that is exactly the problem. It is simply outrageous and plain idiotic, that one has to pay in the neighbourhood of $150 for a five minute nurse exam, and an antibiotic prescription. They will charge you that because they can. And good luck looking for "competition". The competition is not stupid - they know they can charge that too, so why wouldn't they?



What do youexpect to pay? For crying out loud, it costs $50-100 to have your CAR run on the diagnostic machine to find out why the SES light is on. And to do that you just need a minimally trained person to plug into a machine and read the output. At the doctor's office you are checked by a person, as was said here earlier, with 12 years+ of postsecondary education. Then add in the office costs.

Why would you think it should cost less?

To repeat, this is the best filter on overuse of the system. If I have a mild cold, and in fact I may be coming down with one today, I will make a cost/benefit decision. If it was $5 I might go to the clinic because hey, it is $5 why not? But when I got there I would find 100 mamalukes who decided the same thing. The $150 cost, and it is more like $50 than $150 at places like the Walgreen's Clinic, filters out unneeded users.

IOW, if you let economics and the free market work, they will.
All animals are equal, but some are more equal than others
weaselman
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March 31st, 2012 at 6:33:20 AM permalink
Quote: AZDuffman

What do youexpect to pay?


Well, let's see ... If the appointment costs $10, that is 120 bucks per hour for the doc. So, let's be generous, and allow for twice that much. I'd be fine with having to pay $20 for such an appointment. It is still more expensive than in most other countries (where you'd just the script over the phone for free), but it's a start.
Quote:


For crying out loud, it costs $50-100 to have your CAR run on the diagnostic machine to find out why the SES light is on. And to do that you just need a minimally trained person to plug into a machine and read the output.


You are getting ripped off, if you ever paid more than 20 bucks for that. Any moderately honest mechanic does this kind of diagnostics for free around here.
Quote:


At the doctor's office you are checked by a person, as was said here earlier, with 12 years+ of postsecondary education. Then add in the office costs.

Why would you think it should cost less?


Because I am paying for the service I actually receive, not for their education. If your oil change is done by a PhD, you don't expect to be charged more because of that.
Quote:



To repeat, this is the best filter on overuse of the system. If I have a mild cold, and in fact I may be coming down with one today, I will make a cost/benefit decision. If it was $5 I might go to the clinic because hey, it is $5 why not?


The goal of health care is healthy people, not filtering of the overuse or some such. I don't wish anyone to ever be in a position of having to make the ”cost-benefit” decisions involving their own health, much less the health of their loved ones.
Quote:


IOW, if you let economics and the free market work, they will.


This is true most of the time, but not always. I am sure, you are only pretending to not know about various branches of industry and economy, that would never be able to exist without government or communal involvement.
"When two people always agree one of them is unnecessary"
weaselman
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March 31st, 2012 at 7:04:04 AM permalink
Quote: SOOPOO

In all the hospitals in Buffalo that do Obstetrics there is an anesthesiologist in house 24 hours a day for immediate epidural placement, with the legal requirement of a back up available within 30 minutes if a Csection is needed.


Yes, they did have a doc in the hospital, but he got caught up dealing with some sort of emergency.
Quote:


I don't know where you live but I don't want to be there!


Yeah, me neither, that's the point. I'd rather be in Canada.

Quote:

The same can be said about your appendicitis fiasco. The ER calls the surgeon, and from time of diagnosis to the OR is usually an hour or two.

Well, usually

, it is about as long in Canada. But shit happens. On either side of the border apparently.

Quote:

I cannot negotiate with the government. They tell me what I can charge. As an anesthesiologist, Medicaid pays abot 13%, and Medicare about 27%, of what 'real' insurance pays.


I am sure it does, but, I am afraid, for most people, it is kinda hard to be sympathetic, because ”what normal insurance pays” is a lot of money, more, than you would be able to make anywhere else in the world.
Quote:

In the event of a 'one payor system', what level do you expect the government to select?


Well, honestly, I have no idea. I think, there should be negotiations, and serious consideration of various economic consequences. I would expect the final number to be significantly less, than what you get from private insurance, but likely more than what Medicare pays currently. I would also like to point out again, that everybody will be paid for, which is significantly different from the current situation. You will be making less money on each patient, but you will have a lot more paying patients. I would also expect a significant reduction in administrative costs, malpractice insurance etc. The net result, will probably still be somewhat less than what you are making now, but not tremendously less.

Quote:

Additionally, the pipeline of young bright folks, who you WANT to be the doctors of the future, will dry up.


Will it? Why? Will they all go to be nucler physicist? Even if they did, they'd still be making less than a doctor. So, what's the point.

Quote:

There is a reason people do the 4, 4, 4.. (After high school- 4 years of college, 4 years of Medical School, 4 years of Anesthesiology residency)- it's because we get compensated for it.


Well, residency is what most of us, regular people, just call work, that we are stuck with for the rest of our lives, so, that does not count. As for the remaining 4+4, it is not unusual at all to see professionals in many other occupations, that have more that 8 years of training, but make significantly less than a doctor. I am one of them :-)

Quote:

And there is a reason you want it to be that way- you want a well trained doc at your side keeping you alive....


Yes, I do. But I would entrust my life to a Canadian or a European (even, eastern-European) trained doctor, just as easily. Perhaps, we could bring some of them over here on H1, when you guys decide you are better off as nuclear physicists :-)
"When two people always agree one of them is unnecessary"
AZDuffman
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March 31st, 2012 at 7:33:41 AM permalink
Quote: weaselman

Well, let's see ... If the appointment costs $10, that is 120 bucks per hour for the doc. So, let's be generous, and allow for twice that much. I'd be fine with having to pay $20 for such an appointment. It is still more expensive than in most other countries (where you'd just the script over the phone for free), but it's a start.



No, because you are assuming nothing is done besides when they come in and see you. And you are assuming that only the doctor needs to be paid. Rent on the office isn't free, the lights don't come on for free, the nurses don't work for free, the equipment is not free, and the biggie--insurance is not free.

Back to the car example. The mechanic does not get paid the $70/hr you are paying. The charge for labor goes to other costs.

Quote:

You are getting ripped off, if you ever paid more than 20 bucks for that. Any moderately honest mechanic does this kind of diagnostics for free around here.



Depends on the car, where you go, and what you need done.

Quote:

Because I am paying for the service I actually receive, not for their education. If your oil change is done by a PhD, you don't expect to be charged more because of that.



Faulty analogy. You do not need a PhD to change oil. You do need one to be a practicing doctor. It was the same story when I was in pest control and people wanted to know why I got $150 for 20 minutes to knock down a bee nest. I would explain you are not paying for my time, you are paying for my knowlege of how to do the job and my equipment and ability.

Same with the doctor. It cost him or her $500,000 to $1MM to get to the point to educate themselves and set up to see you for the visit. And you expect them to diagnose you for $10-20?


Quote:

The goal of health care is healthy people, not filtering of the overuse or some such. I don't wish anyone to ever be in a position of having to make the ”cost-benefit” decisions involving their own health, much less the health of their loved ones.



And to get healthy people out of the system you must manage the system somehow. Health care is no different than any other service-cost decisions must be made at some point. I want ability to make my own, not have some government burecrat make them for me.

Quote:

This is true most of the time, but not always. I am sure, you are only pretending to not know about various branches of industry and economy, that would never be able to exist without government or communal involvement.



Save the "Steve Jobs would not have been able to deliver his Macs without roads to drive on, so the government helped build Apple!" nonsense. It looks as though that is where you are going. Nobody says we need no government at all. What is being said is that government regs should be minimized. As well, any problems with health insurance in the USA are the result of too much governmnet involvement, not too little.
All animals are equal, but some are more equal than others
Llew
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March 31st, 2012 at 7:51:43 AM permalink
Quote: weaselman


Well, residency is what most of us, regular people, just call work, that we are stuck with for the rest of our lives, so, that does not count. As for the remaining 4+4, it is not unusual at all to see professionals in many other occupations, that have more that 8 years of training, but make significantly less than a doctor. I am one of them :-)



You clearly aren't familiar with the level of hours, debt, knowledge, training that goes into being a doctor, or the many years spent not making much money at all.

FYI we bring over plenty of doctors from other countries on H1B and J1 visas. We even give some of them an exemption to the H1B cap. If we had a single-payer insurance program similar to Medicare/aid, a significant percentage would have much less incentive to come here, and, as described earlier, the supply of health care would diminish significantly. Care would become more expensive as doctors became harder to recruit, lower quality as nurses and other less-trained care providers took on duties previously handled by doctors, and, in some cases, difficult to receive at all, as waiting lists and other forms of rationing became more common.

One of the reasons that health care is so expensive here is that care providers have to overcharge private insurance to make up for losses on treating those with public insurance. Once there's no one left to overcharge, that jig is up.

And of course there is the issue of defensive medicine and legal costs, which are much lower in other countries.

And we also pay non-doctor medical staff quite a bit more than elsewhere, because of nurse's and other white-collar unions.
weaselman
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March 31st, 2012 at 7:56:25 AM permalink
Quote: AZDuffman

No, because you are assuming nothing is done besides when they come in and see you. And you are assuming that only the doctor needs to be paid. Rent on the office isn't free, the lights don't come on for free, the nurses don't work for free, the equipment is not free, and the biggie--insurance is not free.


I work in an office too. I know the costs. Nobody charges their customers 1800/hr for office visits but doctors. Nobody will ever pay such rates unless their health is on the line. If rent is that expensive, tough luck, get a smaller office. Or give me the damn script over the phone.


Quote:

Back to the car example. The mechanic does not get paid the $70/hr you are paying.


Right. But he does not chaarge me $1800 either. Even though his rent is probably more expensive than my doc's office.

Quote:


Faulty analogy. You do not need a PhD to change oil. You do need one to be a practicing doctor.


That was the whole point of the analogy actually. You don't need to be a doctor to write a prescription. An NP can do that. It does not take a PhD, or 12 years of training. But in most places, this stuff is handled by docs because it allows them to bill more. That is exactly like a PhD changing your oil.
Quote:


It was the same story when I was in pest control and people wanted to know why I got $150 for 20 minutes to knock down a bee nest. I would explain you are not paying for my time, you are paying for my knowlege of how to do the job and my equipment and ability.


Rip off. Luckily, unlike with medicine, there is competition, and consumer reason, that sorts these things out. Power of free markets.

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Save the "Steve Jobs would not have been able to deliver his Macs without roads to drive on, so the government helped build Apple!" nonsense. It looks as though that is where you are going.


No, that's not where. Forget Steve Jobs, just think about how nice it is for you to have those roads, and how painful your life would be, if building them was left to free market.
"When two people always agree one of them is unnecessary"
P90
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March 31st, 2012 at 8:05:47 AM permalink
You are not addressing one key issue.
Quote: AZDuffman

you are checked by a person, as was said here earlier, with 12 years+ of postsecondary education.
...
If I have a mild cold... If it was $5 I might go to the clinic... The $150 cost, and it is more like $50 than $150 at places like the Walgreen's Clinic, filters out unneeded users.


That issue is what I just selectively quoted.
You don't need a guy with top 2% academic scores and 12-year education to check out your cold.

When your PC breaks down and you can't get your music, videos and web history, but nothing really valuable, from it - would you rather call a data recovery service that will charge $500 to get the data out with 99% probability, and then another $500 for another company to repair the PC, or your son's college friend who will do both for $100, but only in 95% of cases?

Heavy restrictions on who can practice medicine, what medicines can be sold, possible limitation of liability, etc. essentially make the latter service illegal and only the former permitted. A free market for medical services does not exist in US.
There are times when you need only the best trained doctors, only the most rigorous adherence to standardized practices, and only the most thoroughly tested medicines and procedures. There are also times when you don't. And there are also times when the latter two of these things are harmful to the end result.

However, this choice is removed from US citizens, forcing them to forgo medical services in low severity cases, and in more severe cases forcing many to travel abroad for medical services, that is if they are in a condition to travel.
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weaselman
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March 31st, 2012 at 8:13:19 AM permalink
Quote: Llew

You clearly aren't familiar with the level of hours, debt, knowledge, training that goes into being a doctor, or the many years spent not making much money at all.


Yeah, I am actualy familiar pretty well with that. I am just saying, that most people, who are not doctors, spend their whole lives ”not making much money at all”, and I don't hear them complaining nearly as often.
Quote:


If we had a single-payer insurance program similar to Medicare/aid, a significant percentage would have much less incentive to come here, and, as described earlier, the supply of health care would diminish significantly.


Sure, they'd rather stay in Bombay reading those CT scans for $20 a piece, yeah, right.
Quote:


One of the reasons that health care is so expensive here is that care providers have to overcharge private insurance to make up for losses on treating those with public insurance. Once there's no one left to overcharge, that jig is up.


Exactly! Stop overcharging me! That's the point.

Quote:


And of course there is the issue ...


When there are issues, you look for solutions, not just keep throwing money at them, because you can. Legal costs is not a separate issue - they are directly dependent on the healthcare costs, and on doctor's income.
The hospital staff is overpaid. You don't need a PhD to change bed pads, and you don't need an assistant to take blood pressure. And if someone doesn't like $10/hr for taking 20 blood pressure measurements, they are welcome to go try loading trucks for UPS. Sorry, I did not mean to sound harsh, but let's be serious ....
"When two people always agree one of them is unnecessary"
boymimbo
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March 31st, 2012 at 8:27:01 AM permalink
Quote: AZDuffman


To repeat, this is the best filter on overuse of the system. If I have a mild cold, and in fact I may be coming down with one today, I will make a cost/benefit decision. If it was $5 I might go to the clinic because hey, it is $5 why not? But when I got there I would find 100 mamalukes who decided the same thing. The $150 cost, and it is more like $50 than $150 at places like the Walgreen's Clinic, filters out unneeded users.

IOW, if you let economics and the free market work, they will.



My point is that the free market is not working in the united states because administration as a percentage of total costs is higher than any western country at 31% of total costs and $463 dollars per capita.

And, 42% of americans with chronic health problems avoid care because of the cost. It's more than folks with a cold. These are serious cases of those, with insurance, not wanting to pay the deductible.

And finally, there isn't much in the way of competition, so it isn't a free market.

Quote: AMA, Competition in Health Insurance, 2007


To put this in perspective, in 2000, the two largest health insurers,Aetna and United, had a total membership of 32 million lives. As a result of mergers and acquisitions since 2000, the top two insurers today, WellPoint and United, each have memberships, respectively, of 34 million and 33 million, totaling more than 67 million covered lives. Together, WellPoint and United control 36 percent of the national market for commercial health insurance.

Observers predict that large health insurers will continue to acquire their smaller competitors. WellPoint’s new chief executive officer stated in February that mergers will be one of the key drivers of WellPoint’s future growth. Further, in March, United announced its proposed acquisition of Sierra Health Services, the largest health plan in Nevada. The AMA has asked the U.S. Department of Justice (DOJ) to block the merger, because if the merger is approved United will control 56 percent of the Nevada marketplace (compared
with its current 11 percent market share).

While large health insurers have posted very healthy profits since 2000, premiums for consumers have increased without a corresponding increase in benefits. In fact, during the same time period, consumers have faced increased deductibles, co-payments and co-insurance. This has effectively reduced the scope of their health benefits coverage. It is clear that patients—the ultimate consumers of health care—are not benefiting from these mergers. The AMA is concerned that the United States is heading toward a system dominated by a few publicly traded companies that operate in the interest of shareholders and not primarily in the interest
of patients. It is time for lawmakers and regulators to take a serious look at the long-term negative impact of consolidated
health insurance markets on the nation’s health care system.

....
This study shows unequivocally that many physicians in markets across the country do not have bargaining power with
dominant health insurers and that many health insurers are in a position to exert monopsony power. In 299 of the 313 markets
the AMA surveyed, one health plan accounts for at least 30 percent of the combined health maintenance organization (HMO)/preferred provider organization (PPO) market.



The 2010 summary of this release goes on to say

Quote: AMA


The AMA’s latest findings regarding competition in the health insurance industry include:
* A significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the AMA. These markets rated "highly concentrated," based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission*.

* In about half of metropolitan markets, at least one health insurer had a commercial market share of 50 percent or more.

* In 24 of the 48 states reported in the new AMA study, the two largest health insurers had a combined commercial market share of 70 percent or more.

* The 10 states with the least competitive commercial health insurance markets, are: 1. Alabama, 2. Alaska, 3. Delaware, 4. Michigan, 5. Hawaii, 6. District of Columbia, 7. Nebraska, 8. North Carolina, 9. Indiana and 10. Maine.



So, with providers having the power to dictate prices to its customers, how is that a free market?
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AZDuffman
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March 31st, 2012 at 8:28:20 AM permalink
Quote: weaselman

I work in an office too. I know the costs. Nobody charges their customers 1800/hr for office visits but doctors. Nobody will ever pay such rates unless their health is on the line. If rent is that expensive, tough luck, get a smaller office. Or give me the damn script over the phone.



Now it is $1800 an hour? Where on earth did that one come from?

As for rent, you need the size office you need, in the location you choose. Decent suburban space is probably about $30-40 per square foot. Anything more than a two-room country doctor's office is going to need 4-5,000 square feet. 4,000 * 30 = 120,000 divide that by 12 and you are at $10,000 a month just for rent, or about 500 per day. I will even be generous and say that this includes HVAC and phones (it will not) just in case my sq ft figure is high. So at a $100 office visit you need to see the first 5 people just to open the doors.

Do you still think it is possible to have a $5 or even $20 office visit?


Quote:

That was the whole point of the analogy actually. You don't need to be a doctor to write a prescription. An NP can do that. It does not take a PhD, or 12 years of training. But in most places, this stuff is handled by docs because it allows them to bill more. That is exactly like a PhD changing your oil.



You need to be a doctor or an LPN AFIK. The LPN is limited in what they can write IIRC. I spoke to an LPN while making a delivery to a "Minute Clinic" and the guy there was an LPN who described this to me. The LPNs are good for the person with a cold who needs an antibiotic and some cough syrup. They are good at triage. But their education is about half of a PhD. I am all for this kind of a system, but you still are going to have to spend $50-75 for the diagnosis to both pay this person properly and insure *shudder* profit for the clinic. "Minute Clinic" is probably run at a lower than possible profit to drive spinoff sales from the pharmacy and store in general.

Quote:

Rip off. Luckily, unlike with medicine, there is competition, and consumer reason, that sorts these things out. Power of free markets.



Anyone who doesn't like the price can try something else. I had people in near tears at the fear of the wasps and bees in their home. I had a woman once take her kids in the driveway and across the street "for safety." People who valued getting it done correctly paid. Those that didn't, fine--maybe you get stung and maybe you didn't. But the bottom line is when you pay a skilled person for a service you are paying to get it done, not paying for "time."
All animals are equal, but some are more equal than others
AZDuffman
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March 31st, 2012 at 8:36:51 AM permalink
Quote: boymimbo

My point is that the free market is not working in the united states because administration as a percentage of total costs is higher than any western country at 31% of total costs and $463 dollars per capita.



And my point is that government if it does change this will only make it worse. The US Government invented paperwork. They love it. They will keep adding paperwork and they will "reduce costs" by saying "we will just pay you 'x' for the procedure." Then providers will say, "drop dead, I quit."

Quote:

And, 42% of americans with chronic health problems avoid care because of the cost. It's more than folks with a cold. These are serious cases of those, with insurance, not wanting to pay the deductible.



They don't want to pay for their deductible? Boo hoo hoo. Life has costs. They made a rational choice. Like last year on this board and someone asked if you would pay say $2,000 for a test because the doc was "only 90% sure" he solved the problem. I said I would skip it, maybe get it if I didn't feel better. But if insurance pays then I'd be like, 'sure, whatever." And that is where costs get driven so high.

The best system, as I keep saying, is a minimal hospitalization "catasthropic" policy where you pay up to say $5,000 to $10,000 and put money aside in a Medical Savings Account meanwhile. Most people would have the minimum covered in just a few years of savings, very few if we had an employer match like 401(k). Given lower costs employers woulod jump at this chance. They you can make your own decisions. FREEDOM!
All animals are equal, but some are more equal than others
weaselman
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March 31st, 2012 at 9:00:24 AM permalink
Quote: AZDuffman

Now it is $1800 an hour? Where did that come from?


$150 for 5 minutes is how much per hour?
Quote:



As for rent ...
Do you still think it is possible to have a $5 or even $20 office visit?


Yeah, I do. All businesses in the area have similar expensive.
A barber shop next door is able to afford their rent without charging $600 for a haircut.

Quote:

But the bottom line is when you pay a skilled person for a service you are paying to get it done


What I think the bottom line is, is that a person a desperate enough, you can get them to pay whatever you want. That is fine, if you can. You just don't get to complain about being ”underpaid” when that ability is taken away from you.
"When two people always agree one of them is unnecessary"
boymimbo
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March 31st, 2012 at 9:00:43 AM permalink
Quote: SOOPOO

The 'rate we charge' issue is the most complex. I negotiate rates with all our local insurance companies, and after haggling we have always come to an agreement. I cannot negotiate with the government. They tell me what I can charge. As an anesthesiologist, Medicaid pays about 13%, and Medicare about 27%, of what 'real' insurance pays. In the event of a 'one payor system', what level do you expect the government to select? The guess is they will 'offer' some small increase from Medicare, expecting the physicians to make maybe 40 -50% of what they do now.



Is negotiating a rate an efficient use of your time? Why not have one set rate? Why is the government only paying 27% of insurance company fees? In other countries with socialized medicine, doctors are paid on average about 60% of what American doctors make with a widely varying range. If US medicine is nationalized with insurance companies removed as a source, doctors will get paid less, and there will be less of them in the field, indeed. But I guess there will be one rate schedule, one way to calculate fees, and lower costs, with less administration. Sounds good to me as a consumer.
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boymimbo
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March 31st, 2012 at 9:09:04 AM permalink
Choice? There is no choice. That's my point. You say that health insurance is a free market. It isn't.

AZ, you live in Pennsylvania?

Quote: AMA News, 2009, Pennsylvania to examine its Blues market


Pennsylvania's Blues plans have fallen under scrutiny by state regulators, again just months after two of them dropped plans to merge into a single company.

State Insurance Commissioner Joel Ario said in July that his department would do a market conduct examination of all four Blue Cross Blue Shield-licensed plans "to determine if any of them were engaged in anticompetitive or unfair trade practices in violation of the law," said the department's news release.

The four plans, BlueCross of Northeastern Pennsylvania, Capital BlueCross, Highmark and Independence Blue Cross, for the most part operate in separate regions of the state and dominate that region's market, with the exception of the central region where Capital and Highmark compete.

Ario's announcement was welcomed by physicians who have argued for years that the Blues plans' power is out of proportion and leads to unfair practices, particularly in some contract negotiations with doctors. "Finally, somebody is doing a critical appraisal of this," said Pennsylvania Medical Society President Daniel Glunk, MD. "We've been trying to voice our concerns for a very long time."

Dr. Glunk, an internist from Williamsport, Pa., said concern over Blues dominance dated at least back to the merger of two Blues plans that created Highmark in 1996.

The 4 Blues plans in Pennsylvania have more than 60% of the market.

... "Even with the consolidation off the table, the competitive dynamics of the marketplace have not necessarily improved," insurance department spokeswoman Rosanne Placey said in an e-mail. "The Blues hold the lion's share of our marketplace [more than 60%], and given their longevity here -- of probably 80 years -- it is very difficult for other insurers to compete with the brand they've established."

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AZDuffman
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March 31st, 2012 at 9:10:18 AM permalink
Quote: weaselman

$150 for 5 minutes is how much per hour?



Now it is up to $150 and down to 5 minutes? Never even paid close to that for that short of a time.

Quote:

Yeah, I do. All businesses in the area have similar expensive.
A barber shop next door is able to afford their rent without charging $600 for a haircut.



The barbershop has probably 1/3 the space as the doctor's office. The barber has equipment to be sure, but his equipment is less expensive, lasts longer, and rarely needs to be updated because of a tech breakthru. And at about $1/minute for "time in chair" the barber is not bringing home a paycheck of $120,000 per year. Women pay an even higher rate for more complex work.


Quote:

What I think the bottom line is, is that a person a desperate enough, you can get them to pay whatever you want. That is fine, if you can. You just don't get to complain about being ”underpaid” when that ability is taken away from you.



No, you quit and do some other kind of work, then the patient gets no care whatsoever. And that is what will happen in the USA if we go to a government run system.
All animals are equal, but some are more equal than others
weaselman
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March 31st, 2012 at 9:25:30 AM permalink
Quote: AZDuffman

Now it is up to $150 and down to 5 minutes? Never even paid close to that for that short of a time.


Perhaps, you are including the 45 minutes you spent in the waiting room into the time?


Quote:

The barbershop has probably 1/3 the space as the doctor's office.

I don't know (looks pretty big to me), and I don't care - like I said, if you can't afford a big office, get a smaller one, don't make it my problem because you can.
Quote:


The barber has equipment to be sure, but his equipment is less expensive, lasts longer, and rarely needs to be updated because of a tech breakthru.


What equipment are you talking about? The scale? Or a tonometer? What equipment is necessary to prescribed cold medication? If the barber owned a particle collider, would I be expected to pay for that too?
Quote:

And at about $1/minute for "time in chair" the barber is not bringing home a paycheck of $120,000 per year.


Exactly!
Quote:

No, you quit and do some other kind of work, then the patient gets no care whatsoever.


Nope. Someone less spoiled (and with less sense of entitlement :-), and more entrepreneurship ) just shows up and takes your place... and still makes more than you do with your ”other kind of work”. That's called progress.
"When two people always agree one of them is unnecessary"
Llew
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March 31st, 2012 at 9:26:35 AM permalink
Agree with most of that.

A couple I don't:
The issue of doctors having a difficult time early on is important, because there are several barriers that prevent people from becoming doctors: the cost of school, the aptitude to get into and succeed in medical training programs, the willingness to perform tasks that the squeamish aren't willing to, the drive to make it through a long, grueling process that's not well-compensated at first, etc. Those barriers act as a powerful disincentive for those considering a career as a doctor. What counterbalances it right now is the prospective of a lucrative career. It's the same in many fields. If suddenly actors could only make 100k/film, many current and future actors would give it up and do something else, assuming they had the ability to do so. Likewise in sports. Since doctors are by definition quite accomplished in academics and had to have a good work ethic to get through the school and training, it is very likely that they could enter other lucrative fields in science, engineering, finance, etc. if they chose to do so.

As to whether doctors would rather stay in other countries - it's not a 0% or 100% thing. For every change to the incentive structure, a certain percentage of prospective doctors will change their minds. The percentage of doctors in India who are actively seeking an H1B visa is less than 100%. Some have strong reasons to stay at home. The prospective salary is just one factor. When you alter that one factor, though, you change the balance of pros and cons. Some doctors will not seek a visa for any realistic salary. Others will still seek a visa even if the prospective salary is cut. But there are many who weigh the benefits, including salary, and make a decision based on those.
boymimbo
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March 31st, 2012 at 9:27:24 AM permalink
The number of doctors now in the US is relatively low at 2.3/1,000 despite them getting paid much higher than anywhere else in the world. If you socialize health care, they'll definitely be paid less, and the rate will drop further. But their administrative costs will drop (as administrative fees are much lower in socialized countries and won't have to pay those fees, which will increase their take-home pay) and allow them to concentrate on what they love doing most -- delivering care. Heck, some doctors might even come back to Canada - god knows we need them.

Perhaps one of the factors that keep the doctor level low is the incredible cost of medical school in the United States. In Canada the average cost of medical school is 12,728/year and is on the order of 20 - 35K in the United States. Doctors who graduate in the United States are burdened with an average of $117,000 (public) to $150,000 in student debt (private) with an uncertain future.

So, make medical school cheaper -- that will open up more spots to more students who will graduate with less debt and will work for less money. With 17,264 graduates in 2011 (source: Kaiser), that's about 2 billion, collectively in debt that they graduate with.
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AZDuffman
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March 31st, 2012 at 9:57:25 AM permalink
Quote: weaselman

Perhaps, you are including the 45 minutes you spent in the waiting room into the time?



Nope, but it doesn't really matter because I am paying for knowlege and getting the job done, not "time."


Quote:

I don't know (looks pretty big to me), and I don't care - like I said, if you can't afford a big office, get a smaller one, don't make it my problem because you can.



Yeah, "get a smaller office." Like you actually give any thought to this? What do you want, a small exam room and nothing else? Do try "Minute Clinic" if you want that, they have about 100 square feet, maybe a little more. But a modern doctor's office needs several exam rooms, a waiting room, admin area, and storage area. By the way, the smaller office you want just means fewer patients can be seen and practices will need to be smaller.

Quote:

What equipment are you talking about? The scale? Or a tonometer? What equipment is necessary to prescribed cold medication? If the barber owned a particle collider, would I be expected to pay for that too?



Mine has all you said plus a device to stress monitor my heart, an autoclave, and many other needed items. Sorry I am not a doctor and can only report what I see in there. Why would a barber have a particle collider? It has nothing to do with cutting hair. The doctor would have no need for one, either. Perhaps you would be happier getting an exam under the Cuban system where they reuse needles and tounge depressors so you can have a $5 exam?


Quote:

Nope. Someone less spoiled (and with less sense of entitlement :-), and more entrepreneurship ) just shows up and takes your place... and still makes more than you do with your ”other kind of work”. That's called progress.



Sorry, but you are the one with the sense of entitlement. You want the doctor to make less money, a LOT less, so you can have a $5 office visit. You are the one who is against anyone in the health delivery system making "profit." How is it progress to have someone who invested $200,000+ and 12 years of education to have to throw that all away to make a good living?

Strange definion of "progress."

I don't know about you, but I want the lure of a good living to pull the best and the brightest into medicine.
All animals are equal, but some are more equal than others
boymimbo
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March 31st, 2012 at 10:26:12 AM permalink
To what end. Tell you what, only pay $120,000 for a med school education and make it tough to graduate. Why should the people with money be the ones who go to graduate school anyway? Shouldn't the talented and the smart go -- why should money be a barrier to a higher education?

Then what does the graduate doctor do? Spend 30% of his time doing admin work dealing with multiple insurance providers and being on the phone to negotiate a friggin' rate with a monopoly anyway. How is that progress, or free enterprise, for that matter? Then he spends a good amount of time being wooed by Big Pharma to ply their goods.

I like my *free* doctor exams myself personally. My doctor invested $100,000 or so in an education himself, and hey, he's still practicing in my country. He prescribes what he wants to. He knows what he is getting paid because there's one single list of codes being used. His admin will swipe a health card, punch in a code, and know that he will get paid for his services.
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P90
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March 31st, 2012 at 10:33:14 AM permalink
Quote: AZDuffman

How is it progress to have someone who invested $200,000+ and 12 years of education to have to throw that all away to make a good living?


It's already been said - most medical visits don't actually require a $200,000, 12-year education.

Quote: AZDuffman

I don't know about you, but I want the lure of a good living to pull the best and the brightest into medicine.


Even if it means that the cost of a number of life-critical surgeries will rise above what 70% of your country's citizens can possibly afford, so they'll be effectively cut off?

And I support capitalism and libertarianism. I'm all for the top 30% (or at least those of them willing to become the middle 30% in exchange) being offered access to the best doctors money can get. But only as long as this is done without depriving the other 70% of what help they could otherwise get.

If it was as easy, legally, to set up a doctor's office as a barber's office (and no, one doctor doesn't need 10 exam rooms), this problem would not be present. Or, even, if you could do it with 4 years and $25,000 worth of tuition. Leave some the approvals and whatever in place, for the while being (hopefully short while) - but let the customer decide if he needs them.

Unregulated healthcare may have its drawbacks, but when costs rise to the point where a large part of the populace gets none instead, it's clear that regulations are doing more harm than good.
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boymimbo
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March 31st, 2012 at 12:36:29 PM permalink
Actually, nurse practitioners do alot of the first level work in some socialized countries, thus leaving more complex issues to the doctors.
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EvenBob
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March 31st, 2012 at 1:28:12 PM permalink
You can nitpik everything to death, but it all
comes down to the doctor. The US only produces
75% of the doctors it needs, so the rest come
from other countries, like India. Are these
doctors we're 'stealing' from these countries
from the bottom of their classes? Hardly, their
the cream of the cream, they come to the US
because they'll make more money than anyplace
else.

Take away the money, you take away the expertise.
You'll have bright minds no longer going into medicine.
But we'll all be receiving the same shitty, sub par
care and everything will be 'fair'. Thats whats really
important.
"It's not called gambling if the math is on your side."
P90
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March 31st, 2012 at 3:29:02 PM permalink
Quote: EvenBob

The US only produces
75% of the doctors it needs
...
Take away the money, you take away the expertise.
You'll have bright minds no longer going into medicine.


They don't seem to be going there as it is, or at least so the 75% figure suggests.

Quote: EvenBob

But we'll all be receiving the same shitty, sub par
care and everything will be 'fair'. Thats whats really
important.


Except, you know, the solution where top n% receive whatever top quality healthcare they can pay for, and those with less money, with the market opened, get the same what you call "shitty sub par care" that everyone in Canada, UK, and other such countries seems to somehow survive with.

The life expectancy gap between ER-only healthcare and NHS level healthcare is much wider than between NHS level and US level healthcare (if the latter even exists). There exists an optimum past which throwing more money at a problem not only ceases improving the results, but actually degrades the total score, due to excluding people who can no longer throw their share.
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weaselman
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March 31st, 2012 at 4:52:38 PM permalink
Quote: AZDuffman


Why would a barber have a particle collider?


I have no idea. I am guessing, same reason a regular family practitioner needs heart stress test equipment in the office ...


Quote:

How is it progress to have someone who invested $200,000+ and 12 years of education to have to throw that all away to make a good living?


Progress requires constant change, innovation, drive to improve, and expand.
Investing $200,000, and expecting to be able to sit in the office for the rest of your life, making twice as much per year, is the opposite of progress. It is stagnation.
If more people thought like you, we would still be paying $50 per month for 10 hours of crappy internet access on a 9 baud modem, $2000 for a tiny computer with black-and-white text monitor, and $250 for a flip-phone with $1/minute air-time.


Quote:

I don't know about you, but I want the lure of a good living to pull the best and the brightest into medicine.


Really? How about brightest teachers, best policemen, coal miners, fishermen, scientists, and pilots? Frankly, I would reserve some of the "lure" for them as well ...
"When two people always agree one of them is unnecessary"
AZDuffman
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April 1st, 2012 at 6:05:40 AM permalink
Quote: weaselman

I have no idea. I am guessing, same reason a regular family practitioner needs heart stress test equipment in the office ...



Well, the heart-streee test is there to make a diagnosis, which they seem to do fairly often. A good deal for the patient as it save a trip and time to do it elsewhere. Why you feel the need to make the comment of a particle-collider is still beyond me.


Quote:

Progress requires constant change, innovation, drive to improve, and expand.
Investing $200,000, and expecting to be able to sit in the office for the rest of your life, making twice as much per year, is the opposite of progress. It is stagnation.
If more people thought like you, we would still be paying $50 per month for 10 hours of crappy internet access on a 9 baud modem, $2000 for a tiny computer with black-and-white text monitor, and $250 for a flip-phone with $1/minute air-time.



I don't see the doctor "sitting in his office expecting to make twice as much per year." I do see him seeing patients and working his tail off, all to be called "greedy" by people like yourself because he charges more than $10 for a consultation. And the equipment must be updated and replaced on a regular basis. A doctor practice is a business like any other. It is harder in many cases.

And I honestly have no idea where you are connecting my thought process to slow internet, slow computers, and old-style flip phones. In reality, that is what we would have if we used your system of socialized medicine-comparitively speaking. See, if the governme said, "we have 'negotiated' a low internet price of $20 for all so the greedy providers don't make too much profit' then innovation would cease. The current provider would just keep their current technology as the motive to invest and make a better service would no longer be there.


Quote:

Really? How about brightest teachers, best policemen, coal miners, fishermen, scientists, and pilots? Frankly, I would reserve some of the "lure" for them as well ...



There is plenty of lure for anyone who wants to try these jobs. How do you "reserve lure?" If there a finite supply of "lure?"
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weaselman
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April 1st, 2012 at 6:57:36 AM permalink
Quote: AZDuffman

Well, the heart-streee test is there to make a diagnosis, which they seem to do fairly often. A good deal for the patient as it save a trip and time to do it elsewhere.


And I need to pay for it why exactly?


Quote:

I don't see the doctor "sitting in his office expecting to make twice as much per year." I do see him seeing patients and working his tail off, all to be called "greedy" by people like yourself because he charges more than $10 for a consultation.


It's the same thing, except for terminology. You call it "working his tail off", I call it "sitting in the office". "Working your tail off" in by book is reserved for more intense and productive work, involving some kind of effort, larger than discussing weather with the patient, and then writing in unintelligible script on small pieces of paper.
When I said that getting a simple prescription for a cold medication is not worth hundreds of bucks, and you went on a rampage about how the poor doc has invested into his education, and we must keep paying the outrageous prices because he has costs.
Internet providers have costs too. They found a way to cut them, and reduce their prices by several orders of magnitude while greatly improving their services, so did cell phone manufacturers, cable companies, airlines, etc., etc. That's called progress.
While all that was happening, the family doctor kept sitting in his office, writing same cold medication scripts and rising prices, because "he has invested into his education". That's stagnation.

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A doctor practice is a business like any other.


My point exactly!

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The current provider would just keep their current technology as the motive to invest and make a better service would no longer be there.



Yes, that's exactly what the current medical provider is doing.

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There is plenty of lure for anyone who wants to try these jobs.


Well ... they are all making orders of magnitude less money then the doctors are. Many of have invested about as much time, and comparable amount of money into their education. Some of them invested even more. If there is enough lure for them, how come, all the docs would covert to burger flippers if they had to lose a fraction of their income and give some thought to reducing costs?
"When two people always agree one of them is unnecessary"
AZDuffman
AZDuffman
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April 1st, 2012 at 7:32:38 AM permalink
Quote: weaselman

And I need to pay for it why exactly?



You are not paying for it directly. You are paying to go to an equiped office. This costs more than the $5-10 you seem to think you should pay. Some things they charge for directly, like a heart stress test. Some are indirect, like the cost of occupying the office. You are free to go to a small office in a bad part of town and not "pay for the office" if you like, we have a free market after all--at least for now.


Quote:

It's the same thing, except for terminology. You call it "working his tail off", I call it "sitting in the office". "Working your tail off" in by book is reserved for more intense and productive work, involving some kind of effort, larger than discussing weather with the patient, and then writing in unintelligible script on small pieces of paper.



YES, it finally comes out. You take the attitude of most liberals that "work" = "physical effort." This is not true in the real world. In the real world, knowlege is almost always more valuable than just doing physical work. Medicine is one of the best examples. My guess is you think the orderly who cleans the hospital does more "work" than the doctor. Save it, please, for your nearest OWS meeting. I know better.


Quote:

When I said that getting a simple prescription for a cold medication is not worth hundreds of bucks, and you went on a rampage about how the poor doc has invested into his education, and we must keep paying the outrageous prices because he has costs.



I didn't "rampage." And now instead of $150 it is "hundreds of bucks," eh? But yes, when you want something that takes a lot of knowlege to obtain you have to pay more for it.

Quote:

Internet providers have costs too. They found a way to cut them, and reduce their prices by several orders of magnitude while greatly improving their services, so did cell phone manufacturers, cable companies, airlines, etc., etc. That's called progress.



What color is the sky in your world? In 1997 dial-up cost $19.95, today high-speed is close to $50. Five years ago a basic cell phone was $100-200 but today an iPhone is $600 (retail, not the reduced price with your plan.) Cable has more channels but at more cost. So why is medicine an exception? Better stuff costs more. people want better stuff.


Quote:

Well ... they are all making orders of magnitude less money then the doctors are. Many of have invested about as much time, and comparable amount of money into their education. Some of them invested even more. If there is enough lure for them, how come, all the docs would covert to burger flippers if they had to lose a fraction of their income and give some thought to reducing costs?



I don't know of any doctor that would convert to being sa "burger flipper" if he left medicine. Well, maybe they would open a restauant. But a high-skill person like that has a world of other things they can do for a living. As to the other occupations and what they invest, they were free to become a doctor. Maybe they just had no interest in being one (I never did.) Maybe they didn't have the apptitude. Maybe they liked the job they picked better? Why do you care in the first place?
All animals are equal, but some are more equal than others
weaselman
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April 1st, 2012 at 8:28:08 AM permalink
Quote: AZDuffman

You are not paying for it directly.


Ok, let me rephrase. Why do you think I am supposed to pay for it indirectly?

Quote:

You are free to go to a small office in a bad part of town and not "pay for the office" if you like, we have a free market after all--at least for now.


Nope, we don't. The price is set by the insurance, and they don't care what part of town the office is. I can go to a small office (I do, actually), but I will end up paying the same price. We do not have free market, far from it. That's the point.


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YES, it finally comes out. You take the attitude of most liberals that "work" = "physical effort."


No, I don't. I said "effort", you said "physical" ... and put it into my mouth. Like most liberals do.

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But yes, when you want something that takes a lot of knowlege to obtain you have to pay more for it.


Yes, if I do, then I have to. But in this case, I don't ... but still have to.

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In 1997 dial-up cost $19.95, today high-speed is close to $50.


Yeah ... And a particle collider is even more expensive.
Do you happen to remember how much high speed was in 1997? I do ... Do you know how "high" the "high speed" really was?

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Five years ago a basic cell phone was $100-200 but today an iPhone is $600 (retail, not the reduced price with your plan.)


Right. And a Boeing today is worth hundreds of millions. Good comparison.
How much do you have to pay for a flip phone today?

Quote:

So why is medicine an exception? Better stuff costs more. people want better stuff.


Medicine should not be an exception, that's the point. Aspirin prescription is not any better today than it was 30 years ago, just more expensive.
Why is it an exception you ask? Why is everything getting cheaper while medical services are getting more expensive? Simple.
Because they can.

Quote:

As to the other occupations and what they invest, they were free to become a doctor.


Yep. As well, as the doctors were free to become something else. If they get disappointed in their 6-figure income at some point ... well ... tough luck.
Quote:

Why do you care in the first place?


Me? I don't really ... I actually think, we might be better off, if some people, who think that $300K a year is not "good living", stopped being doctors and went to try themselves in ... I dunno ... some other profession where they think they'd consistently make more for decades with less effort or investment. Good luck.
You were the one to bring it up, how you wanted to "lure" good people into being doctors, by promising them those tremendous earnings, better than anywhere else in the world. I just said that if there was indeed any sense in "luring" people into certain occupations, then there is a whole bunch of other professions, besides medicine where I would not mind seeing good people.
"When two people always agree one of them is unnecessary"
boymimbo
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April 1st, 2012 at 9:36:46 AM permalink
The price of health care has gone up substantially not due to doctor's fees going up. It's due to the cost of medical supplies, prescriptions, and diagnostic services that have increased in complexity and therefore price. I worked finance in Canadian health care for 7 years (mind you, at the end of the last century) and know how hospitals were pressured to cut costs as the prices in medical supplies rose much faster than anything else in the industry. And it's true today. That concoction of drugs to treat AIDS costs a hell of alot of money, as do treatments for cancer, parkinsons, and any chronic disease. These treatments have saved lives.

Doctors and the AMA as a lobby have their interests: they want to keep other people from doing their job and they want to have free enterprise so that health care providers such as BCBS, Wellpoint, and United can't dictate their prices. That's why I was easily able to pull facts and figures about health care providers from the AMA's web site. Doctors make lots more money when they have a monopoly on the services they provide and can charge the price that they want to. The same of course is true about any industry, be it steel, health care, lawyers, consultants, and the like.

With socialized medicine, doctors will make much less money, probably on the order of 20 - 40% less. Insurance companies will be relegated to selling extended health care that covers prescriptions, enhanced hospital care, and things outside of what the government provides. Tens of thousands of jobs will be lost, many of them in overseas call centers. There will be one fee structure for all treatments, wiping out administrative hassles and haggling of fees. Many will retire, but there will be plenty of people to replace them. Some of them are just passionate at medicine and want to help people rather than make a ton of money doing it. Lower the financial barriers to medical school and the colleges will stay fully enrolled. Students will graduate with smaller loans to pay.

I agree with Weasel that it's a waste of a doctor's time to renew a prescription or do a service that say, a qualified nurse could easily do for alot less money.

It doesn't matter anyway. Health insurance companies and the AMA are so far up the asses of congressment and senators that no decent legislation that will help the American consumer will ever come along. Health care prices will continue to rise, as there is no competition, only consolidation, and no need to become more efficient. Employers who need to compete in a global market will continue to cut benefits to their employees, putting an effective tax on their employees who now have the choice to buy less services and be more at risk or pay alot more for the same level of coverage. It's hard for the American family to prosper when they are geting a raise of say 2% a year but their health insurance costs (to them) go up 10% a year.

But hey, it's the greatest system in the world! Middle of the road in all meaningful categories, and more expensive by 50% (7,538 per capita, 2008 vs $5,003 per capita, 2008 for Norway) of GDP over its closest westernized neighbor. Those Norwegian commies and their lousy quality of life!
----- You want the truth! You can't handle the truth!
AZDuffman
AZDuffman
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April 1st, 2012 at 9:42:09 AM permalink
Quote: weaselman

Ok, let me rephrase. Why do you think I am supposed to pay for it indirectly?



Because you want to use a full-service medical office. Just as if you use a full-service auto dealership. They don't know what your problem will be, so they equip to be full service. This requires constant updates and replacement pruchases. Same at the doctor's office.


Quote:

Nope, we don't. The price is set by the insurance, and they don't care what part of town the office is. I can go to a small office, but I will end up paying the same price. We do not have free market, far from it. That's the point.



Then pay cash at the doctor's office and forget about the insurance. You can call around town and compare prices. Insurance should not cover something so small as a regular visit anyways.

Quote:

No, I don't. I said "effort", you said "physical" ... and put it into my mouth. Like most liberals do.



It is a synonomous term as to the point you are making. Not sure why you would equate me with a liberal. You are the one with the liberal viewpoint here.


Quote:

Yeah ... And a particle collider is even more expensive.
Do you happen to remember how much high speed was in 1997? I do ... Do you know how "high" the "high speed" really was?



Still the fascination with particle colliders. I don't get it.


Quote:

Right. And a Boeing today is worth hundreds of millions. Good comparison.
How much do you have to pay for a flip phone today?



A Boeing what exactly? They make many products. I didn't price flip phones because I wanted a state of the art smart phone. Most consumers want the same.


Quote:

Medicine should not be an exception, that's the point. Aspirin prescription is not any better than it was 30 years ago, just more expensive.
Why is it an exception you ask? Why is everything getting cheaper while medical services are getting more expensive? Simple.
Because they can.



To the best of my knowlege aspirn has never required a prescription. But new drugs require research. Aspirn came out in 1899 and all the research costs were ammortized long ago. But if you want the newest blood pressure meds, well, research goes into them and that cost money. So your choice if you have high blood pressure is: A-buy a bottle of aspirn for $1, hope for the best or B-buy the new blood pressure meds that have been tested to do the job, they may cost $20 a bottle.

You are, of course, free to take your aspirn, use your flip-phone, and reply to this post on your dial-up modem. This will cost you less, but you are getting less. NEW technology costs more; OLD tech that does nothing new falls in price over time.


Quote:

Me? I don't really ... I actually think, we might be better off, if some people, who think that $300K a year is not "good living", stopped being doctors and went to try themselves in ... I dunno ... some other profession where they think they'd consistently make more for decades with less effort or investment. Good luck.
You were the one to bring it up, how you wanted to "lure" good people into being doctors, by promising them those tremendous earnings, better than anywhere else in the world. I just said that if there was indeed any sense in "luring" people into certain occupations, then there is a whole bunch of other professions, besides medicine where I would not mind seeing good people.



Again, good people are free to go where they want to go. There is not some "Trilateral Commission" that says "We will lure people to be doctors this year and engineers next year." But if the market demands more good doctors than engineers then the salary for doctors will go up and more people will consider that as a profession, a good thing.

What you want is to take away a big incentive to become a doctor, namely cash. Just like when they controled the price of gasoline in the 1970s. You had a low price, but the tanks at the station were empty. Do you really prefer to pay $5 a doctor visit but have to wait a month to get an appointment? That is what your ideas will lead to.
All animals are equal, but some are more equal than others
weaselman
weaselman
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April 1st, 2012 at 9:42:27 AM permalink
Quote: boymimbo

The price of health care has gone up substantially not due to doctor's fees going up.


It does not matter. The fact is that price of virtually any other service is going down, while this one is going up.
I don't have anything against doctors personally, don't get me wrong. Just saying that the system is broken.
My cold medication prescription (the piece of paper, not actual drug) isn't worth the insane amount of money I am charged for it, however you spin it. I am not saying it's doctor's fault. It isn't. If I was in their shoes, I would charge as much for it, too ... Because they can.
"When two people always agree one of them is unnecessary"
weaselman
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April 1st, 2012 at 10:23:23 AM permalink
Quote: AZDuffman


Because you want to use a full-service medical office.


No, I don't, thank you very much. I just want my prescription.
And it is not full service anyway. If I have a heart problem, they will refer me to a cardiologist, who will do all the tests anyway (because they want to bill for them too).
So, no, I don't want "full service".
Quote:

Then pay cash at the doctor's office and forget about the insurance.


Except, if you pay cash, it is more expensive, then even what the insurance pays. They get "group rates".

Quote:

It is a synonomous term as to the point you are making.


Well ... liberals might think that (according to you), so, it looks like you agree with them.
For the record, I don't think "effort", and "physical effort" are synonyms. It would just be plain stupid if they were - the word "physical" would have no meaning whatsoever.

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Not sure why you would equate me with a liberal.


Because you are employing their tactics.

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You are the one with the liberal viewpoint here.


Not really. I consider my viewpoint humanitarian, and rational, not liberal in the usual sense of the word.

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Still the fascination with particle colliders. I don't get it.


I know. Just like I don't your comparing price of dial-up with high-speed internet.

Quote:

A Boeing what exactly? They make many products. I didn't price flip phones because I wanted a state of the art smart phone. Most consumers want the same.


We are discussing the point about progress being able to reduce prices overtime on every product or service except medical.
You are comparing a price of a basic phone to that of a tiny computer. That is about as meaningful as comparing it to the price of a Boeing (any product, take your pick, it does not matter).


Quote:

To the best of my knowlege aspirn has never required a prescription.


No, it did not. But sometimes you get it.
Just a few weeks ago I got a prescription of Ibuprofen for my back ache. It does not require a prescription, but they still write it. Why? Beats me.
Anyway, it does not matter, consider antibiotics prescriptions (they are required) if you prefer, or Lipitor ... The point is, the prescription is a little piece of paper with a bunch of unintelligible characters scribbled on it. It has not become any better over the years, just like a flip phone, just a lot more expensive.

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But new drugs require research.


Yes, they do. I am not talking about prices of drugs. I am talking about cost of a prescription.


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Again, good people are free to go where they want to go.


So, you don't want to "lure" them anymore? Changed your mind?

Quote:

But if the market demands more good doctors than engineers then the salary for doctors will go up and more people will consider that as a profession, a good thing.


But why do you think the market in US "demands" more good doctors than anywhere else? We are not healthier than Europeans (nor are we sicker, thus requiring more care) or Canadians, we do not live longer ... we are not exactly on top of the world in terms of engineering ...

Quote:

What you want is to take away a big incentive to become a doctor, namely cash.


And what you want is to take away a big incentive to become anyone but a doctor by giving all the cash to doctors.
"When two people always agree one of them is unnecessary"
boymimbo
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April 1st, 2012 at 10:47:50 AM permalink
What I think is known is that US health care is the most expensive in the world, by any measure, but that statistically, by all measures, the US is in the middle of the road when it comes to performance.

I think what's been demonstrated is that health care is not a free market economy. The providers have > 50% market share in most metropolitan areas, allowing them to dictate terms and prices. This is widely known.

It's also been demonstrated that health care insurance companies are not efficient. More than double the money, per capita, is spend on administrative fees than any government-run healthcare elsewhere. Just because it is run by government doesn't mean it will perform any less efficiently than an insurance company. Absolutely, it will run less efficiently than say, MicroSoft, Google, or Apple.

Thirdly, if you are a health care provider, like a doctor's office, clinic, or hospital, your staff spend a great deal of time haggling over prices, and you routinely don't get paid from the uninsured. This is not an efficient business model where over 10% of your "sales" doesn't get reimbursed. Effectively, you don't know what price you get to charge for your service until just before the service is rendered, because as a provider, you can't set the price.

Fourthly, a substantial proportion of the population (>40%) avoids health care because of the cost despite the fact that they have a chronic condition requiring care. Another substantial part of the population is uninsured at any moment in time.

And, health care prices continue to rise. Families are becoming more burdened with the deductibles, less coverage, and more premiums as employers offload insurance to the workers.

So, what's the solution? It isn't ObamaCare. I hope that it isn't Canada either, for your sake. But there are plenty of countries with enough experience in socialized medicine that you could pick and choose the best of all worlds to come up with the best health plan in the world. I still believe that the US is the best country in the world and the most innovative. It just has to get the lobbyists out of their butts and do what's right, whatever that may be, because what you have isn't working.
----- You want the truth! You can't handle the truth!
SOOPOO
SOOPOO
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April 1st, 2012 at 11:44:43 AM permalink
This thread is driving me crazy!!! Blessedly, I don't write prescriptions like a family doctor or an internist, but I must stand up for them. You are not paying them 'for the prescription', but for the doctor listening to your history, examining you, and coming up with a plan, be it prescription medicines, additional tests, or whatever he recommends.
Someone said something like everything else is getting cheaper but medical costs are rising. I just paid 3 times as much for an international air ticket than I did a decade ago, gas is probably at that multiple, a single top quality golf driver now costs what a set of clubs did a decade ago, etc....
Medicare pays me about the same as it did in 1990. The increasing costs that our federal government is paying is NOT going to doctors.
EvenBob
EvenBob
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April 1st, 2012 at 12:32:28 PM permalink
I'm going to bring this up yet again. My sister in law is
CANADIAN and the wonderful medical program they
have there would let her DIE rather than pay for her
meds. So she comes to the STATES and its covered
under her husbands insurance.

What don't you understand about substandard care?
Great care for the healthy and kinda sick. Get real
sick and you're screwed. But at least its 'fair'.
"It's not called gambling if the math is on your side."
boymimbo
boymimbo
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April 1st, 2012 at 12:56:33 PM permalink
Yeah, I know, Bob. I've said, plenty of times, that our system in Canada is far from perfect. Drugs are only covered under our socialized medicine program for senior citizens and the poor. In some provinces, prescription medicine is income tested, meaning that if you are under a certain income, your drugs are partially covered. However, phamaceutical coverage in Canada mainly comes from your employer based plan. That means that if you are unemployed, you are out of luck. Government does not pay for pharmaceuticals in Canada. They pay pretty much everything else, however.

In Ontario, for example, some drug coverage is covered under the Trillium Drug program which covers senior citizens and those collecting social assistance. In British Columbia, your drug coverage is income tested. A family earning $50,000 / year will have 70% of their drugs covered after a $1,500 deductible.

So, while I hear "let her die", it is the same for everyone in Canada. Employers generally offer a drug plan to their employees. If your sister-in-law had a drug plan through employment, she would be covered. If your brother was working in Canada, he would also likely be covered.

For me, for example, I have an extended health program through my workplace, that covers medical, dental, vision, etc. My drugs are covered to a certain amount each year with a $25 annual deductible. If i lose my job, I lose my coverage, immediately.
----- You want the truth! You can't handle the truth!
EvenBob
EvenBob
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April 1st, 2012 at 1:00:08 PM permalink
edited
"It's not called gambling if the math is on your side."
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