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View Diary: An outsider's view of US health care (84 comments)

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  •  confusion (none)
    Ok. I entirely agree that the US system is flawed, but I haven't ever found the answer to "what do you propose" to be quite simple. I'm in university in Montreal right now and have spent some time exploring their health care system - and i'm not quite sure if its the solution. If you go to the emergency room of a hospital, 6 hours later you're likely to still not have seen a doctor. Furthermore, the care is free but theres a lot of loopholes. The ambulance to the hospital isnt free and the medicine isn't free. Now, I know the medicine is much cheaper than in the states, but the tax rates are also much higher - so its not a clear cut issue. Anecdotally, I know people who have funds and choose to go perform operatioins in the states because they'd rather not wait a year/or two in canada. Along these lines, Quebec recently had to send some very ill patients into the US for treatment because there weren't enough facilities in Canada.

    Please don't interpret this as an endorsement of the US health care system. I'm just wondering if anyone can clearly explain how we can avoid these problems with a larger population and geographic area.

    •  Year or two? (4.00)
      I'm having a hernia operation (not at all life threatening) after five months. Since I'm self-employed, if I were in the United States I'd probably have to wait until I was wearing my guts for garters.

      Delays in Canada are a result of the level of funding. Thus, if Canadian taxpayers want a faster system, all they have to do is lean on the politicians to feed more money into the system. If that's not democratic, I don't know what is.

      If you want to see a doctor, why don't you just go to a clinic? You rarely have to wait more than an hour in one of those. Emergency rooms are for midnights and holiday Sundays. At least that's the way it is in BC; don't know about Quebec.

      And what gave you the idea Canadian tax rates were much higher than American ones? You have to take all levels of taxation into account -- property taxes here in Vancouver are far lower than they are in many American metropolises, for instance.

      "Salvation is by way of the truth, not by way of the fatherland" -- Chaadaev

      by sagesource on Sat Mar 26, 2005 at 05:41:29 PM PST

      [ Parent ]

      •  Employer contribution (4.00)
        In response to something a while back I started looking into OECD figure for taxation.  I was suprised to see that in many countries while the overall rate of taxation was much highier, this included the employer social security contribution.  And while the employee and employer contribution in the US were equal in the Nordic countries the employer rate was 32% of income, while the employee paid only 8% or so.  For that matter, according to the OECD figure I'm look at here, excluiding employer contriubtion tax rates are actually lower in Canada.  See the difference between the "All In" and "Total Tax Wedge".  As for the theory that all employer contribution is income that otherwise would have increased the income of the worker, I'm more than a little dubious.
      •  interesting (none)
        hmm.  interesting.. i'm going to have to crunch some numbers to try and figure out tax rates. .thanks
    •  I have extensive experience with both (4.00)
      the Canadian and American health care systems, plus my husband is a physician in the U.S. (and an American--he is not a Canadian who left Canada to make more money in the U.S.).
      I have many Canadian relatives, most are middle class, some are genuinely wealthy, and all use the Ontario provincial health care system without complaint. The baby boomers are inquisitive and knowledgeable and tend to engage with the system in the city or the nearby suburbs where it seems to work very well for them. It is less than stellar in the in outside in more rural areas where development is just starting to happen (this is the kind of area where my elderly parents live and it is not working out that well because in their county the services are not as well developed).
      There are shortages of doctors (but that could be alleviated almost immediately by immigration). The government just announced an big increase in the number of spots for GPs in medical schools. Unfortunately, there is a brain drain to the U.S. When the U.S. finally gets a national health care system, then Canada will not have so many problems keeping doctors. Finally, the government has rationed care by not having enough equipment such as MRIs. This was a deliberate decision and a bad one. People are very angry about it and they have started to deal with it. (Note that in the United States there is already plenty of equipment so if we were to change to a single-payer plan, this wouldn't pose the same kind of problem.)

      However, the United States is no panacea for a doctor. I do not mean to imply that it is not a good living, but in my husband's case he is on the staff of a well-known hospital and he is in one of the lowest-paying specialties, psychiatry. Please hear me--the salary is not the issue. The conditions of work and the priorities of the health care system ARE the issue. Pediatrics and psychiatry are very labor-intensive and are therefore not profit centers for hospitals so they don't see them as valuable. (In fact my husband's hospital just got rid of their pediatrics department. They prefer to do glamor medicine like transplants.)
      The most wasteful part of the whole system is the mixtures of health insurance that people have. Health insurers are DEDICATED to finding ways to DENY YOU COVERAGE. My husband often has to go on the phone for hours to patch together some kind of continuity of service for someone who is very sick. He gets a lot of automated answering systems and a lot of bureaucratic guff. He has to fill out extensive forms from health insurers and the government repeatedly on patients. (Do you think this is a good use of his time?) Plus they are asking him to see patients in ten minutes and make decisions about complex cases very quickly and NEVER make a mistake.

      •  My son just got a bill today (4.00)
        forwarded to my address, For an ER visit last month in Berkeley. It was for a mental health issue, no tests or Xray, just trying to manage a serious panic/anxiety attack. He was there 5 hours, saw a doctor for ten minutes. The bill was $780 for the ER and $220. for the doctor.When he graduated from college last year, he was no longer eligible for our HMO plan, so this hospital bill will not be covered by insurance.He moved back here to Boston shortly after that ER visit. He now has two part time jobs (so no health insurance) and is trying to get his life back together. He has hardly any money for food, so I am not even going to show him this bill right now.I dont want him to feel he can't go to a hospital if he has a future emergency.
           I plan on calling The Berkeley Medical Center and see if I can negotiate a lower amount and then pay it off over time. I would hope they go for it since the alternative is they send this to Collection to try to collect from a young man with no steady income and a somewhat fragile emotional psyche right now. So they would get nothing. I feel they should be paid and I will take care of it somehow...but,I do hope they will work with me on it.
           He called me and asked if I could find him someone to talk to , since he has been feeling 'bad' lately. For him to ask me for help tells me he is feeling more than just "bad".  He doesn't qualify for any assistance and there is quite a waiting list for free mental health care and I think he needs to get started seeing someone soon. I told him I would take care of it.( I haven't got a clue how, but this is my kid and he needs help!) He told me again how thankful he is to have me  and of course, I got all choked up. If my love could cure him, he would be all better because I have an endless supply of that....just very limited funds. I'm neither poor nor rich, but after paying my own family health insurance  plan at $1350. per month ( the one that used to include him), it seems wrong that he can't get what he needs. He has lots of friends his age...none have health insurance.
           An employer based health insurance system is wrong. His two employers told him they keep everyone under 25 hours so they don't have to pay health insurance. Can't say that I blame small business owners, we are in the same situation. Sigh...sorry for the rant...and all the details....I'm just worried about my kid.
        •  I am sorry you and your son are (4.00)
          having such a hard time getting reasonable health care for him and that it is costing so much. I have heard many stories like this (and the coverage for mental health is not even good when you have insurance). There are many studies at Massachusetts General Hospital in the Dept. of Psychiatry and they are always advertising. If your son could go there he might be able to get into one and get some care for awhile. It must be very hard to have him so far away when he is going through this.
          •  Thank You (none)
            for your thoughts. Luckily now he is close in Boston...I am also in Massachusetts. When he was in California and going through the emergency, that was very difficult, not being near. I wanted to fly out there immediately but just couldnt afford to. I'm glad he wanted to come closer to home. We have had some good talks and he has improved greatly. I'll look into the Mass General thing....thanks. One way or another I will make sure he  gets what he needs. I feel bad for those who don't have a support system.

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