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Little known fact: Health care in America is funded by the government to a greater extend than in Canada. Between Medicaid, Medicare, Military Health Care, and emergency room services for the non-insured or the under-insured, the American government pays US $2,728 per person per year for health care.

In Canada, the government pays only US $1,893 per person per year. That's 30% less.

With that money, the Canadian government manages to cover everyone with world-class quality care. Even though the American government is paying more per head, its money only manages to cover a small fraction of its population, with the rest being left to fend for themselves with private insurance companies. These companies charge higher prices for coverage than even the USA government spends, let alone the Canadian government (about US $8000 per year) and outright refuses to offer their services to 20% of the population.

This leaves the United States with the largest population in the world without access to health care, and the highest rates of bankruptcy. In the US having a medical emergency often means going bankrupt. Bankruptcies arises whether or not you have private health insurance coverage since private insurances cover so little (when they do offer coverage) that their disbursement are rarely sufficient to avoid bankruptcy. 62% of all bankruptcies are caused by medical events.

The strangest aspect of American health care is the presence of folks who are rabid defenders of the American system, who speak without any awareness of the current system's failings, and without any knowledge of the alternatives.

The case of death panels angst is particularly poignant, since one keystone pillar of the new health law is to force private insurances to abolish their "Do Not Treat" list -- from 20% (mentioned above) down to near zero. The law:

  • Forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that)
  • Says health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit".
  • Says insurers can't just drop customers once they get sick.
    Forbids "pre-existing conditions" for kids under the age of 19.

and on January 1st, 2014,
  • no more refusal of care because of pre-existing condition at all.

The law does all this without establishing any new form of government coverage (Medicare, Medicaid, Military health care, and uninsured health care remain largely unchanged.) What list could "death panels" possibly be referring to? Nothing at all, that's what.

Then there are the claims about the amount of money different governments have to spent, claims that certain numbers ought to be ruinous, yet the arguers never put in the effort needed to look up the numbers. In many anti-Obamacare posts, the key thing to notice are the appearances of the word "handout", which reveal the nature of their conception of the role of government.

While governments are generally constructed to take care of domains where the private sector does poorly (such as health care -- the specific economic reasons are too long for this post, but are covered in most introduction to economics textbooks, if you are curious). Anti-handout people understand governments principally as a transfer of wealth to receivers of handouts. This attitude is also known as class-war-ism, and is one of the most corrosive forces in modern American politics.

Government spending source, Wikipedia

For more details on the content of the new Obamacare law, read this fantastic post in the fantastic subreddit titled Explain It Like I'm Five.

Originally posted to gmarceau on Sat Sep 21, 2013 at 08:00 PM PDT.

Also republished by Community Spotlight.

Poll

What is the best functioning institution of health care in the United States?

67%157 votes
6%16 votes
17%40 votes
0%1 votes
0%2 votes
4%10 votes
2%5 votes

| 231 votes | Vote | Results

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Comment Preferences

  •  Definitely Mediacare. (23+ / 0-)

    Wherein you operate on yourself while a doctor tells you what to do via a webcam.

    •  Oh. Please. (0+ / 0-)
    •  You: This is going to hurt a bit! (1+ / 0-)
      Recommended by:
      marykk

      Media Doc: Well, do it anyway!

      To put the torture behind us is, inevitably, to put it in front of us.

      by UntimelyRippd on Sun Sep 22, 2013 at 07:59:41 AM PDT

      [ Parent ]

    •  Where does Medicare fit in? (0+ / 0-)

      With the hype?  Since I read kos I am familiar with Mediacare and all the fluff of O'care.

      •  Medicare is crap (2+ / 0-)
        Recommended by:
        salmo, Cream Puff

        unless you supplement it with private insurance.

        As for Canada spending less on heath care than the US, this is looking at it in the wrong (not "uniquely American") way. The US has the best health care system in the world -- for insurance companies.

        And since insurance companies write US health care law, this is no surprise.

        •  Enrolled in Medicare? (4+ / 0-)
          Recommended by:
          Curt Matlock, marykk, pixxer, Cream Puff

          I have been quite happy since I made the cut two years ago.  I sure hope the bar is not raised any higher.  I know many who would be happy to sign up.  In terms of bang for the buck it is hard to beat with a "loss ratio" of 3%.  Compare that with the 30% "loss ratio" of the for profit O'care exchange plans.
          None of the participants I know call it crap.  Please expand on your discontent.  It makes me curious.

          •  Medicare is saving my life. (3+ / 0-)
            Recommended by:
            pixxer, splashoil, hestal

            I have had a quintuple bypass, 10 years ago next month, and type II diabetes, undiagnosed for many years, treated with daily insulin pen injections and pills, along with diet etc...

            Medicare - along with the new ACA prescription provisions - save me almost $300 per month in prescription costs and at least that in private health insurance payments. Since I retired early to care for my chronically ill wife, my retirement income is meager, and Medicare allows me to eat, feed my dogs and drive my cars...to LIVE my life as well as pay the medical business. FWIW, I dropped my supplement insurance after realizing they don't actually pay for much of anything, saving me even more.

            I have no complaint with Medicare at all, but I wish it could be extended for everyone rather than having them rely on the fraudulent health insurers.

            mark

            What doesn't kill me had better start running.

            by old mark on Mon Sep 23, 2013 at 06:48:21 AM PDT

            [ Parent ]

            •  I'm on Medicare, two years now. (0+ / 0-)

              The open enrollment for supplemental insurance is coming up, and I'm seriously considering dropping it.  In two years they have paid less than $200 for Medicare-approved expenses, and I have been paying almost $200/month for the "coverage."  I'm healthy except for high cholesterol which I can lower with diet and exercise.  I take no prescription medication.  

              How is that "no supplemental insurance" action working out for you?

              "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

              by SueDe on Mon Sep 23, 2013 at 08:33:21 AM PDT

              [ Parent ]

              •  Exactly. But you will have to pay 20% (0+ / 0-)

                for everything other than visits to your GP. And since GPs these days pretty much just refer you to labs and specialists, that isn't very helpful. OK, it can help you control your bp and cholesterol; for anything else, if you can't afford the 20% copay, you don't get medical treatment.

                Medicare is crap.

                •  Medicare works very well (0+ / 0-)

                  and that 20% is on controlled costs.

                  Imagine:

                  year 1 appendix out - $1100 part A deductible + $130 part B deductible + 20% of $1,000 surgeon's bill ~= $1,500

                  year 2 gallbladder out - $1100 part A deductible + $130 part B deductible + 20% of $1,200 surgeon's bill ~= $1,550

                  year 3 broken leg - $1100 part A deductible + $130 part B deductible + 20% of $1,500 surgeon's bill ~= $1,600

                   

          •  The loss ratio is the (0+ / 0-)

            percentage of premiums used to pay claims.

            The PPACA requires an insurer's loss ratio to be above 80% in the individual market and 85% in the group market (or premium rebates will have be made).

            The 3% is the very low and very efficient Medicare claim paying processing expense percentage (for a loss ratio equivalent of 97%).

          •  Yes, I'm enrolled in Medicare (0+ / 0-)

            It pays for my visits to my GP. Then she sends me off to have MRIs and see specialists, and I can't afford the 20% copay -- so I still don't get medical care.

            Medicare is crap.

        •  Well, that is just not true. (0+ / 0-)

          I was a member of the team that developed the first Medicare payment system which quickly became the most widely such system. I worked thirty years after that providing a wide range of systems to Medicare carriers, Medicaid carriers, HMO's of several types, private health insurance companies, self-insured groups, and even a system for Saudi Yanbu a joint venture between Mobil Oil and the Saudi government. During that thirty year period I enjoyed excellent benefits from private insurance companies through my employers, and when I went into business for myself, I offered excellent group insurance benefits to my employees as well. So, I have been deeply and continuously involved with all forms of health insurance for decades now.

          When I enrolled in Medicare in 2004, I deliberately chose not to buy supplemental insurance, and I do not have drug coverage of any kind. I have only Medicare and my pocket to pay for my health care. I have diabetes for which I take two medications daily, and frequent kidney stones which sometimes have to be pulverized. I have had two mild strokes so I take cholesterol medicine to protect against future strokes. I have atypical narcolepsy and the medications for this are very expensive, but I have to stay awake so...

          In short, when I compare my overall out-of-pocket costs to those of my friends who have supplemental insurance I am ahead of the game. When they combine their premiums and their total cash payments for deductibles, etc. they spend more than me on medical care.

          This is not surprising. Overall,  buying supplemental insurance is a losing proposition for the buyer. The Medicare advantage programs were especially expensive on a net basis.

          I get to see my doctors (five specialists) when I need to, so I am not subject to inferior or delayed care.

          As I travel this last part of my life, I am extremely satisfied with Medicare and I have many friends who feel the same way.

          Might and Right are always fighting, in our youth it seems exciting. Right is always nearly winning, Might can hardly keep from grinning. -- Clarence Day

          by hestal on Mon Sep 23, 2013 at 09:22:20 AM PDT

          [ Parent ]

          •  Evidently your pocket is fuller than mine (0+ / 0-)

            Mine is only filled monthly by SSDI, and I can't afford either supplemental insurance or to pay specialists out of pocket.

            The result is that I don't get medical care. I go to see my GP (which is covered), then she refers me to a specialist with a 20% copay I can't afford.

            Medicare is crap.

            Apparently, I'm not wealthy enough to hang out on DKos. I was never a member of a team that developed any government policy. I was once a tolerably well paid Silicon Valley engineer, but then I had a gender transition, which meant the end of that career and perpetual poverty ever since.

            •  Medicaid/SSI (0+ / 0-)
              Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

              Thirty-two states and the District of Columbia provide Medicaid eligibility to people eligible for Supplemental Security Income (SSI ) benefits. In these States, the SSI application is also the Medicaid application. Medicaid eligibility starts the same months as SSI eligibility.

              The following jurisdictions use the same rules to decide eligibility for Medicaid as SSA uses for SSI, but require the filing of a separate application: Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, Northern Mariana Islands

              The following States use their own eligibility rules for Medicaid, which are different from SSA`s SSI rules. In these States a separate application for Medicaid must be filed: Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, Virginia.

              http://www.socialsecurity.gov/...
            •  Medicaid by state info (0+ / 0-)

              http://www.medicaid.gov/...

              [upper right of page]

            •  I am not wealthy. I have Social Security (1+ / 0-)
              Recommended by:
              SingleVoter

              income and savings accumulated over thirty years of working steadily. I live in a small Texas town with a low overall cost of living. I miss some of the conveniences that city life offers, but I do not want to outlive my savings account.

              Might and Right are always fighting, in our youth it seems exciting. Right is always nearly winning, Might can hardly keep from grinning. -- Clarence Day

              by hestal on Mon Sep 23, 2013 at 04:57:25 PM PDT

              [ Parent ]

            •  What is "c...." (0+ / 0-)

              is a low and insufficient income.

  •  Great 1st Diary, Welcome! (29+ / 0-)

    We pay so much more per head because our insurance is so much private for-profit, which is illegal in the rest of the developed world. We have to pay not just for the care and the insurance costs, but also top corporate executive compensation, competitive returns to investors, and marketing expenses among other costs.

    Increasingly our treatment facilities are also for-profit, so those same non-care profit expenses must also be paid to the caregiving institutions.

    And in the profit system, the near ruinous training costs of becoming a practitioner must return prodigious profit to the practitioner so they can clear their educational debts soon enough to afford to start families before they age out of the opportunity.

    You can't swing a dead paramecium by the tail without hitting one immorality after another of the American profit-based health system.

    Come to think of it there's 1 too many words in that sentence, and it starts with "he."

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sat Sep 21, 2013 at 08:23:18 PM PDT

    •  Thanks for the welcome! (12+ / 0-)

      This is actually my second piece! I co-wrote the other piece, and it ended being posted under her account. It's here, titled, "Stop Copying the GOP! Helping Liberals Get Smart About the Deficit"

      Actually, small doctor practices in Canada are for-profit, as well as some hospitals, and that's working well. They are required by law to only receive payments for the universal insurance coverage, so the space for exploitative abuse is much less.

      It's really the insurances that cannot be left to the market.

    •  Another cost chomper (3+ / 0-)
      Recommended by:
      Betty Pinson, onionjim, salmo

      here is the fee for service model in which everything is priced out both separately and expensively.

    •  There is a diary to write (4+ / 0-)

      about spending and costs.

      Three examples:
      1.  The US Government spends about 9% of GDP on HC and covers those over 65 and some of the poor.  Canada spends the same amount and covers everyone.
      2.  Education - the US Government spends more on a per capita basis than most countries in the world.  In some of those countries University education is much cheaper.  In the US we are driving our children into debt.  Again, it isn't really the amount of money if looked at on a % of GDP basis.
      3.  The New York City MTA is building a new line in Manhattan.  Costs are about $3 Billion a mile.  The MTA did a study and found that London and Paris pay about $250 million a mile.  The workers in all three cities are in unions - so that isn't it.  The MTA is in the process of doing a study.

      The inefficiency of the US Government compared to its peers is something seldom discussed.

      It should be.

      •  It isn't government inefficiency (9+ / 0-)

        (Well, maybe the MTA is: don't know about that). The US Government is actually a very efficient operator of an insurance plan (Medicare) and a complete healthcare system (the VA). But most medical delivery and billing in the US is done through private insurance companies. This is a major cause of inefficiency and high cost. The mere fact we don't have single payer has spawned a whole industry of complex billing and claims processing that aims to shift costs to patients or other insurers as much as possible.

        •  There are multi payer (5+ / 0-)

          systems in Europe that are more efficient as well.   Its more than just the admin overhead though.  See the NYT piece on the $500 dollar bag of seawater at a New York Hospital

        •  The biggest cost problem in U.S. (0+ / 0-)

          health care delivery is not the insurance overhead (15-20% under ACA), although that's a chuck of change that could be used for care.  It's twofold:  the cost of our fee-for-service system and the cost of prescription drugs.  

          The lack of regulation of every product and service in the U.S.health care system is the overarching problem.  Providers are going to have to accept strict regulation eventually.  The doctors, medical device manufacturers and pharmaceutical companies will bitch and moan; the opponents will scream "No!" and stamp their feet and make up scary phrases like "death panels" and "socialized medicine," but the sooner the war over regulation is waged and won, the more wasted money will be wrung out of the system and the nearer our per capita costs will be to those of the rest of the developed world.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Mon Sep 23, 2013 at 09:06:06 AM PDT

          [ Parent ]

          •  pages 149 and 150 of the PPACA (0+ / 0-)
            Beginning on January 1, 2015, a qualified health plan may contract with—
            ....
            (B) a health care provider only if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.
            Secretary Sibelius has the unilateral legal power to make the doctors treat the poor for free on pain of being cut off from health insurance payouts.
          •  There is also exchange overhead (0+ / 0-)

            of ~3.5%.

            This may be levied as a (unsubsidized?) surcharge even though the PPACA suggested it be included in the insurer's overhead costs.

            Remember 3.5% on a $8,000 plan is $280/year.

      •  MTA (3+ / 0-)
        Recommended by:
        ichibon, Sherri in TX, Nailbanger

        A lot of the difference could be tunnelling costs. Manhatten is solid rock whereas in London designers attempt to follow the clay band that makes boring and excavation a lot easier. Recent new lines have re-used sections of old permanent way which saves costs - examples are the new "Overground" outer circle line that uses parts of old and existing main line rail tracks as well as odd bits of route like the old East London line and Crossrail that is to provide an West-East service with a long tunnel from Paddington to the East end.  

        By the way, a couple of stations on Crossrail are due to cost over $1 billion because of the complex interchange and upgrade to stations required at Tottenham Court Road and Canary Wharf although much of the cost of the Canary Wharf development is being paid for by the owners of the buildings complex. Similar funding will come from the developers of the site of the old Battersea power station in contributions towards the cost of an extension/ spur to the Northern Line from Kennington.

        We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

        by Lib Dem FoP on Sun Sep 22, 2013 at 09:16:53 AM PDT

        [ Parent ]

    •  A lot of things go in there (0+ / 0-)

      First, private insurance.  If you essentially eliminated the underwriting and other expenses related to trying to keep only healthy people on the insurance (this is much larger than marketing), you'd take a huge chunk right there.  On top of that, there are a lot of inefficiencies in billing and claims processing; you also need to factor in hidden overheads (claim submission by providers, insurance support in HR departments -- without private health plans and privatized pensions, the whole HR profession would die, and not be missed.)

      Second, perverse incentives, and more generally plain ol' gaming the system by providers.  My doctor's reimbursements have been flat for the past two decades, a significant drop adjusted for insurance.  Her income doesn't go down (and has held up reasonably well) because her insurance administrator is good at her job.  Hospitals are fantastically good at this: they even know how to work around stuff like New Jersey's mandatory DRGs.  

      Third (I'm not sure this isn't just more perverse incentives) we seem to generate a lot more medical procedures than other Western countries.  Per capita, France has half the colonoscopies as the US (and they cost much less).  They don't have more colon cancer than the US.

      Fourth, certain medical specialties are incredibly well compensated in the US.  Like everything else, this is a small group of elite doctors; a doctor on salary doesn't make any more than in the rest of the world.  But the average compensation for doctors is much higher.

  •  American living in Canada here (6+ / 0-)

    I think most people here agree with your diary and understand that the American health care system is both grossly inefficient and fails to cover a large number of people.  I agree with that.  However, your statement that the Canadian government provides everyone with "world-class quality" care is simply incorrect.  I know most Americans refer to the Canadian system as a means of comparison because they are next door, but there are better systems out there: Japan, Israel, Australia, Switzerland.  The Canadian health system is notoriously spotty geographically.  In Montreal finding a family doctor is nearly impossible, and finding an OB/GYN for normal pregnancies?...fuggetaboutit.  Yes, I'd say its better than the US for sure, but that is sort of like saying "hey, this granola bar tastes better than poop!"

    •  I prefer the granola bar over poop anyday. (3+ / 0-)
      Recommended by:
      wilderness voice, salmo, Bisbonian
    •  What is " world-class quality" anyway? (5+ / 0-)

      that sounds like marketing more than a meaningful metric. I'm guessing the diarist and others who say that are thinking of the life expectancy figures that show the US trailing most (all?) western nations, including Canada.

      As for the availability of doctors, the Montreal problem sounds similar to Massachusetts, which may be the only state that already has a universal coverage system in place...does Canada lack for medical schools? Or is there a problem of doctors going for specialties and moving to the US to make the big $$? We have a huge problem in the US with lack of family doctors, because the pay scale is so much lower than for, say, neurologists.

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Sun Sep 22, 2013 at 08:56:28 AM PDT

      [ Parent ]

      •  I can answer that (1+ / 0-)
        Recommended by:
        SingleVoter

        I recently got a spinal operation in Montreal.  Orthopeadic surgeons are in extremely short supply.  The young resident there told me it's not a question of lack of graduates in the field, it's the government nickel-and-diming hospitals on specialist positions.

        I don't know much about other provinces, but the healthcare system in Quebec is burdened with legacy inefficiencies, bloated superhospital construction delays and chronic under-funding.  It takes emergency room wait scandals for the government to take minimal action to address the worst problems.

        I'm surprised that ALL medical graduates in Canada don't follow the brain-drain to lucrative US practices.  But it seems many professionals are less money-grubbing than I thought.  They'll only move if there is no decent alternative to staying in Canada.  It may be family ties, familiarity or a sense of duty to use their expertise where public funds helped train them.

        All that being said, for all its drawbacks the Canadian system works.  The people want to improve and expand it, not privatize it.  Heart patients might complain about spartan post-op care and long waits for follow-up appointments, until someone points out their operation was free.

        Whatever its inefficiencies, I'm at least glad that my tax dollars are overwhelmingly going to fund actual healthcare, rather than Wellpoint executive bonuses and administrative paper-shuffling designed to shift costs around.

        First they came for the slippery-slope fallacists, and I said nothing. The End.

        by Cream Puff on Mon Sep 23, 2013 at 08:19:43 AM PDT

        [ Parent ]

      •  The federal government (0+ / 0-)

        determines the residencies that are funded and the types of doctors produced.

        A medical school graduate can only ask to be admitted to a residency program.

        It obviously helps to be a good-looking female if one wishes to be a dermatologist or eye doctor based on what I've seen locally.

    •  Got something against granola bars? (9+ / 0-)

      It's true that the Canadian system has been struggling with the problem of physician supply, especially I think since the Mulroney years, but the important lesson there is also pretty simple: It is difficult to have a civilized society when there are powerful and active interests who are deeply, angrily opposed to civilization and to society.

      Canadian sociopathic conservatives have been trying to subvert, obstruct, and destroy Canada's medicare system pretty much from the day it was created. They haven't been as savage and spiteful about it as the Republicans have been about the ACA, but they have, indeed, waged an unending war to make the system as inefficient and ineffective as possible, so as to engender its eventual collapse.

      The most basic problem of physician supply -- not enough trained physicians in the population -- is one of the most trivially tractable imaginable government problems. Cuba can do it, for god's sake. If you want more doctors, you pay for the training of more doctors, under a contractual basis that requires them to practice in Canada, on the government's terms, or pony up a Large Sum of Money.

      And in fact, Canada has mostly solved the physician supply problem, in the sense that overall there are more than enough trained doctors to go around. In fact, currently there is a shortage of candidates for the openings in some training programs, and unemployment among new physicians is real. Canada's specific problems with physician supply are tied to the fee-for-service model, more than anything else. This makes it difficult for rural physicians to earn a living (can't see enough patients within a reasonable geographic radius), and makes it difficult for new physicians to get a place in an established practice.

      Another way of understanding this is to realize that Canada's physician-supply problems are due almost entirely to the system's being insufficiently socialist, rather than excessively socialist.

      At some point, some reasonably astute Canadian MBAs are going to realize that they can start opening chains of clinics, putting their doctors on salary with reasonable working hours and job security, negotiating terms with rural communities (e.g., the communities provide the facilities -- including mobile clinics, the companies provide the doctors, possibly in rotations).

      However, as always the for-profit solution is extremely sub-optimal, and provinces are themselves moving in this direction, putting docs on salaries, for example.

      Ultimately, most of what is "wrong" with Canada's healthcare system can be fixed, not with major reforms, but with simple and sensible reforms.

      The single most significant reform is one that needs to be implemented, not just in medicine, but in all careers that require advanced academic and practical training: Treat the training systems as "normal" jobs. Medical residents should be compensated commensurate with their overall level of experience and education.

      A 23-year-old chemical engineer with a new master's degree spends an enormous fraction of her time learning on the job -- and she is compensated about $75 an hour (counting cost of benefits) for that time. Moreover, her employer doesn't charge her for the books, the journal subscriptions, the supervision or any formal/informal training, the office and desk, or the training courses and conferences she attends. By the time she is 27 or 28, and is trained comparably to an MD finishing a residency and she has (if she has chosen to) paid off her student debts, while moving forward with her other personal goals.

      Compare her to a 27-year-old brand-new postdoc molecular biologist. This person has worked equally hard, or moreso, but has never earned more than 15 or 20 thousand dollars a year. That's a putatively "half-time" salary, because the person is not paid for the time spent learning to do whatever job she is going to do. Often it is explicitly otherwise: Newer grad students are paid half-time for teaching other people, while working an additional full-time on the training. Broke and indebted, perhaps wanting to start a family with a significant other whom our new PhD has spent sadly little time with over the preceding 4 years or so, she is now searching for a 2-year "post doc" position. This job will pay something in the low 40s (less than she would be making if out of high school she had taken a clerk position at a convenience store while attending community college, then become an assistant manager, and with 10 years in had been a manager for the last couple of years); this job will come with the expectation of long and inconvenient hours, doing work that might never bear fruit. It will be understood to be temporary -- she cannot with any confidence put down roots, because she very likely will be moving to another state in 2 years. (And unlike the MD, she is never going to make 200K or 300K per year!)

      If you want to improve physician availability, nothing would be more effective than to humanize the training systems so that a 30-year-old MD isn't looking back at a train-wreck of delayed responsible adulthood and punitive overwork, while looking forward to crushing loan payments, lunatic work schedules, and an overall sense of being owed something special for having sacrificed so much.

      To put the torture behind us is, inevitably, to put it in front of us.

      by UntimelyRippd on Sun Sep 22, 2013 at 09:26:15 AM PDT

      [ Parent ]

      •  This could stand as a diary on its own. nt (3+ / 0-)
        Recommended by:
        Cory Bantic, Mary Mike, atana

        A society grows great when old men plant trees in whose shade they know they shall never sit. - Greek proverb

        by marleycat on Sun Sep 22, 2013 at 10:05:15 AM PDT

        [ Parent ]

      •  No (1+ / 0-)
        Recommended by:
        Roadbed Guy

        I don't have a problem with granola bars.  I do have a problem with everyone telling me how great, grand, wonderful, stupendous, utopian, friggin' orgasmic the Canadian health care system is.  All I'm saying is to come down to reality and recognize that, while I prefer it to the alternative (if the alternative is the US), but that I don't think we should all sit here and drool over what we imagine Canada's healthcare system to be without recognizing its very real problems.  Why must we always use the Canadian system as a model when there are many others that are even better.

        •  These are US citizens talking (4+ / 0-)
          Recommended by:
          salmo, Bisbonian, Orinoco, Cream Puff

          The Canadian health care system seems like paradise compared to the US.

          Personally I want an extended version of the British NHS: not only should the health care providers work for the government, but so should the entire pharmaceutical industry. This would solve the problem of drug price gouging and the constant shortages in drugs that aren't huge money makers. And it would put research back in the public sector, where it belongs.

          •  I wonder why (4+ / 0-)
            Recommended by:
            salmo, on the cusp, Bisbonian, SingleVoter

            Nobody considers the Japanese system?  I lived there for a couple of years and it was fantastic.  The national insurance premiums were really cheap, service was excellent, efficient and clean hospitals, the doctors generally had great bedside manners.  

            •  One of the more extraordinary data items (3+ / 0-)
              Recommended by:
              salmo, on the cusp, Bisbonian

              in the report whose data is the basis for this diary, was the fact that Japan has, by a very, very long yard, the highest proportion of CT and MIR machines per capita.

              I was quite surprised.

              To put the torture behind us is, inevitably, to put it in front of us.

              by UntimelyRippd on Sun Sep 22, 2013 at 03:56:35 PM PDT

              [ Parent ]

              •  Huh (0+ / 0-)

                Since CT and MRI services are more applicable to "free market" principles (more uniformity of service, ability to price, less urgency) than other forms of healthcare, I thought the US would be #1 in that category.

                Either the Japanese government is serious about major investments in health or they're in the pocket of Big Magnet.

                First they came for the slippery-slope fallacists, and I said nothing. The End.

                by Cream Puff on Mon Sep 23, 2013 at 08:32:23 AM PDT

                [ Parent ]

        •  You're oversimplifying (0+ / 0-)

          The term "world-class" is debatable, but the point of this diary was to show the disparities between government spending and coverage.  It's an important point. Krugman has written about this too.

          I and other Canadians regularly point out the many shortcomings of Canadian healthcare without resorting to Foxnewsish hyperbole and cherry-picking.  Most policy wonks agree that the French and German systems work better overall than Canada's or the UK's.

          First they came for the slippery-slope fallacists, and I said nothing. The End.

          by Cream Puff on Mon Sep 23, 2013 at 08:28:07 AM PDT

          [ Parent ]

        •  Perception Bias (0+ / 0-)

          Hyakuban, you're basing a lot of your criticism on a very small sample size of Montreal, which is currently dealing with huge issues through the public service as well as a choatic tug of war between rural, urban and Francophone priorities in the health care system. Most of the 'notoriously spotty' nature of the Canadian health care system really breaks down to two things; physician retention outside of the cities, and family doctor access inside the cities. Part of the reason finding a family doctor is so difficult is because of Canada's aging Boomer population, and a limited number of doctors replacing old practices. It is a problem, but it's ultimately a self-correcting one.

          It's not to say that there aren't problems, but their problems are similar to those going on right now in the Japanese or Australian health systems. Believe me, I've got first hand comparisons between them, Canada, and many of the European ones. They have roughly the same regional issues and specialist limitation challenges as Canada.

    •  One of the silliest measures of (1+ / 0-)
      Recommended by:
      Greenfinches

      good care is " finding an OB/GYN for normal pregnancies." There is no need for an ObGyn for normal pregnancies.

      Much better results come from using well trained Midwives, who are graduate nurse practitioners who can recognize and refer the few problem pregnancies and refer to a doctor.

      The take over of deliveries by physicians by medical doctors was a deliberately engineered practice to increase doctors incomes in the 1850s.

      Countries with better infant and maternal mortality rates use Midwives far more than we do.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Mon Sep 23, 2013 at 02:11:10 PM PDT

      [ Parent ]

  •  Americas big profits health care system (6+ / 0-)

    is the the most expensive on the planet and it will not work in it's present form.

  •  gmarceau, great diary, thank you! Plan on sharing (5+ / 0-)

    widely to help counter dis-information/mis-information about the ACA & healthcare insurance in general.

    Your poll needs extra options, such as "all the above" or ability to choose more than one :) to accommodate those with experience with several.

    Until I was in my late 20s, I was covered via military healthcare.  'Tis all I ever knew & it was a major (and very disorienting) shock to experience "civilian" healthcare/insurance/costs for the 1st time.

    Then, for around 17 years, through a medicaid waiver program called the Katie Beckett Deeming Waiver or TEFRA, my child with disabilities has had excellent healthcare coverage.  

    Similar to my own experiences from childhood until adulthood with military insurance, everything has been covered without ever seeing a single solitary bill or statement (unless asked for).

    No out of pocket expenses, no co-pays, no premiums.  No agonizing over where to find the monies for the current $700+ monthly prescriptions or for the numerous specialists & diagnostics & medical interventions.  

    Instead, the KB/TEFRA Deeming Waiver allows my child & other medically needy children enrolled to live within the community (home) at far lesser expense than if in an institution.  Purportedly saves state & feds money.

    I'm not quite aged enough yet to benefit from Medicare so I cannot compare it to healthcare insurance I have experienced.  I do know that my parents enjoyed excellent healthcare on Medicare plus Tricare For Life.

    "Civilian" insurance has been another story-a roll of the dice.  When employed with a foreign held company (French) healthcare benefits were astonishing; the same held true for an innovative start up company.

     Everything in between ranged wildly from garbage insurance that covered very little to good.  Very telling was when the French company sold to a US company-that golden astonishing heath insurance vanished....along with a whole bunch of non medical perks....

    With so many successful government models already in place, it boggles my mind that these could not just be tweeked & then expanded to include all.

  •  There are tons of other "hidden" costs, too (8+ / 0-)

    (1) Employer tax deductions for employee healthcare plans (~$147 Billion per year)

    (2) The privatization of former public assets (link 1) and the use of taxpayer money to expand and invest in private healthcare facilities (link 2). Those examples are from Louisiana in particular, because it's relevant to MY interests, but I am not naive enough to think it doesn't/couldn't occur elsewhere.

    It's pretty clear to me (and to you as well, according to your diary) that healthcare is not a viable for-profit market. The "truly sick" will not make you money, unless they have lots of it. And it isn't like buying a television, where we make a choice based off how it appeals to us. If I have the flu, I want rid of the flu. I don't want to replace it with something else. I didn't break my collar bone on purpose, but because someone rear-ended me on the highway.

    Alas, most of this will fall on deaf ears, and I simply do not understand how.

  •  As in UK (5+ / 0-)

    If you look at the figures in terms of national GDP, the UK and USA spend almost exactly the same percentage on publicly funded health services - the figures vary depending on the more recent new hospital etc developments in the UK so the two countries tend to swap places as to which spends the greater %age in any given year.

    One difference is that in the USA, total health expenditure is more than double whereas private medicine adds about half as much again in the UK, bringing the total to around 14% of GDP.  By contrast, the USA was rapidly approaching 20% although the ACA may well affect this rate of increase. The British National Health Service is funded for the most part from taxation including what is in effect an income tax on both employer and employee totalling about 20% of the employee's income, shared between the two. However this "National Insurance Contribution" also covers a basic sickness income, unemployment benefits, health and retirement pensions.

    We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

    by Lib Dem FoP on Sun Sep 22, 2013 at 05:14:09 AM PDT

  •  I hate the claim "it makes health costs higher.." (0+ / 0-)

    Because it neglects the fact that defaults and debt to hospitals drives all of our debts higher regardless.  

    You are correct and at a certain point this becomes a matter of pulling off a bandaid.  People will whine for a while about how much it will hurt removing the adhesive strip, but once it is off, the healing begins.

    Gandhi's Seven Sins: Wealth without work; Pleasure without conscience; Knowledge without character; Commerce without morality; Science without humanity; Worship without sacrifice; Politics without principle

    by Chris Reeves on Sun Sep 22, 2013 at 07:03:05 AM PDT

  •  We are paying way too much (1+ / 0-)
    Recommended by:
    ybruti

    for lesser service.  Single payer/Medicare for all is the obvious solution.  Krugman has a graph showing this very plainly.

    He who would trade liberty for security deserves great customer service.

    by Publius2008 on Sun Sep 22, 2013 at 07:04:17 AM PDT

    •  Medicare isn't really "single payer" (1+ / 0-)
      Recommended by:
      on the cusp

      You have to supplement it with private insurance or be ready to pay 20% out of pocket for most medical services.

    •  Medicare as is (1+ / 0-)
      Recommended by:
      SingleVoter

      pays 80% of costs for Parts A & B, plus full coverage for some "preventive" care. But Part D (prescription drug coverage) really sucks. One of the things ACA is doing (too slowly for me!) is remove the doughnut hole. I'm deep in the doughnut hole myself, right now, and will probably get out of it just in time for the next calendar year, when I need to pay my deductible...

      New signature coming soon!

      by NYWheeler on Tue Sep 24, 2013 at 06:58:56 AM PDT

      [ Parent ]

  •  The Canada "single payer" mantra is (2+ / 0-)
    Recommended by:
    wintergreen8694, atana

    a flawed description insofar as the government pays about 70% of costs and the rest is left up to the consumer (either out of pocket or from private insurance).

    Thus the Canadian government doesn't "cover" everyone with world class health care - at least assuming that world class health care includes things like dental care and pharmaceuticals.

    •  Single payer refers to the provincial medical plan (1+ / 0-)
      Recommended by:
      UntimelyRippd

      which pays the bills for covered medical services. Canadian doctors have only one fee schedule and one "insurance company" to deal with and don't have collections and bad debt issues to deal with (other than for international deadbeats).

      I doubt that ANY country pays for all medical services - cosmetic surgery being the most obvious example. What to cover is a provincial political decision; most have opted not to pay for pharma, psych, phsyio, dental, vision, cosmetic. The main obstacle is an unwelcome import from the U.S. - voter disapproval of tax increases and user charges.  (My province has a pharma plan which is of most benefit to low-income residents.) Inclusion of dental services is being considered by several provinces because of its important role in other diseases.

      I believe the author was using "world class health care" to refer to the level of care - MRIs, CTs, cutting-edge research (e.g. recent HIV vaccine Phase I trial),  hospital hygiene standards, etc. representative of 21st century medicine. Using this definition, even the U.S. would qualify, despite its poor record of medical errors and in-hospital infections and less than stellar results in terms of life expectancy.

      •  The chief difficulty... (3+ / 0-)
        Recommended by:
        atana, salmo, on the cusp

        ...is the doctors. There's something about going through medical school that turns a noticeable percentage of graduates into pigs.

        There are many fine doctors in Canada, but there are also more than a few greedy pigs who seem to spend most of their time thinking of ways to squeeze extra money out of their patients. One example is extortionate charges for transferring medical files to a new doctor, which should be free, goddamit (they're your documentation, after all). Since there is no regulation specifically limiting or forbidding charging for this, many doctors now hit their patients for a hundred dollars or more to pick up a stack of papers and mail them to a new address.

        "They smash your face in, and say you were always ugly." (Solzhenitsyn)

        by sagesource on Sun Sep 22, 2013 at 09:32:04 AM PDT

        [ Parent ]

        •  A book from the 70's made the point that (0+ / 0-)

          few doctors remain idealistic about their profession only five years after getting their degree. Instead, according to The Solid Gold Stethoscope, they begin to view their MD as a license to print money.

          The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

          by ybruti on Sun Sep 22, 2013 at 10:07:12 PM PDT

          [ Parent ]

  •  I've heard that most hospitals in this country (0+ / 0-)

    receive mega millions each year from the federal government to cover the costs of the uninsured; this includes for profit. However, many hospitals instead use that money to pay for new construction of facilities. They somehow cook the books and get away with it....is this true?

  •  Chasing down references (1+ / 0-)
    Recommended by:
    ybruti

    Government spending source, Wikipedia

    Go to Wikipedia, find a link to a CRS paper, search through the CRS paper.

    ".....the American government pays US $2,728 per person per year for health care.

    In Canada, the government pays only US $1,893 per person per year."

    This likely comes from table 1 of http://assets.opencrs.com/...

    where 2004 US per capita health care expenditure is given as $6102, with 44.7% of that publicly financed (= $2727.59, as stated $2728) and Canada as $3165 with 69.8% of that publicly financed ( = $2209.17, not $1893 as stated).

    Further, "the American government pays" != "publicly financed" and is a bit misleading.  State and city governments also spend some of their revenue on health.

  •  This diary is a huge wake up call for anyone (1+ / 0-)
    Recommended by:
    on the cusp

    who wants to understand more about what we spend. We need to run some numbers here though. If we spend more and insure that much less people, then we need to figure out how to insure everyone and have it be near what Canada pays. For some reason, I don't think it will be anywhere near that, and why not? Where is the money going? Right now we know it is going to insurance companies' pockets, but how do we get to that model in Canada? I know some here say 'just do it' but if we just said everyone covered for everything, where are the cost controls? How do we know what things 'actually' cost now that insurance is out of the way? And how do we sustain that? These are questions that I wish someone much better in analysis than I would get to.

  •  Actually the Veterans Adminastration (4+ / 0-)
    Recommended by:
    atana, on the cusp, ybruti, Orinoco

    is probably the best dollar for dollar. It is rated very high.

    Join the War on Thinking. Watch Fox News- John Lucas

    by Jlukes on Sun Sep 22, 2013 at 02:18:18 PM PDT

  •  Fantastic YT video on this from John Green (1+ / 0-)
    Recommended by:
    on the cusp

    He really breaks it down very, very well. We pay more in taxes for health insurance than any other nation on earth and yet only those of us over 65 are covered. It's crazy.

    The problems that exist in the world today cannot be solved by the level of thinking that created them. - Albert Einstein.

    by Cvstos on Sun Sep 22, 2013 at 03:44:46 PM PDT

  •  Excellent Diary (2+ / 0-)
    Recommended by:
    88kathy, on the cusp

    Thanks!

    It reminded me of the observation that insurance companies seek to privatize the profits and socialize the losses.  That certainly is/was the case with lifetime limits, rescission of coverage, and other tricks of their trade.

  •  You just made me think of a meme I think in (0+ / 0-)

    meme's.

    ACA to get what we pay for.

    (You used to call it obamACAre)

    Great diary. Insurance companies take the money for medical care, but they do not give medical care.

    Another Seinfeld episode.

    You know how to take the money for medical care, you just don't understand how to give the medical care.

  •  Aside from the fact that ALL dollars are (0+ / 0-)

    government issues, money is a convenient measure of relative, not absolute value.
    Consider, for example, the completely healthy person whose annual expenditure, whether in person or by a surrogate, is zero. That person is in an ideal situation. Because, despite the marketing moniker "health care," it's not health that's being cared for and, indeed, care is not what a healthy person needs. Though it may be desired--a reality that was addressed by the Medicare Advantage plans' delivery of spa services and nutritional advice.
    The reason medical services, like fire suppression and flood prevention, are best delivered by a public corporation, which is not looking to make a profit, is because profit, especially sustained profit, is generated by repeat custom and the last thing we want is for injury, fire and flood to recur. So, these disutilities are most appropriately dealt with by an organization content with measuring success in terms of less.
    That's the obverse of the market where success is measured as more.
    (Sometimes, opposites are actually relevant).

    As a matter of convenience and because seven is easy to remember, I've identified the seven i's to be addressed by our public organizations:

    inundation
    incineration
    invasion
    injury
    infestation
    incarceration
    ignorance

    Note that in each instance, attention is focused on natural forces, rather than the persons who might be affected. This may account for why the Cons are ineffective. Their focus is almost entirely on motivating, directing and incentivizing persons. Personal responsibility is what they are after. The natural environment might as well not exist. It does not figure into their perception of what is.

    •  One disagreement (1+ / 0-)
      Recommended by:
      hannah

      You need to understand how American social conservatives parse these issues.

      If you're assumption is that the problem to be solved as "giving people the healthcare they need" or "keeping people healthy" (the way I suspect almost everyone here defines it) then our system is absurd.

      However, the rightward part of the country views health care issues as a matter of morality.  The use of the term "choice" in US health care literature is a very ideologically loaded statement -- the choice is a moral one, and you need to make the "correct" choice.  While it's utterly unclear what the "correct" choice is, the penalty for getting it wrong is illness.  (Some conservatives are not far removed from directly presuming illness to be a manifestation of God's displeasure with someone, and indirect and less drastic versions of this view are a fundamental part of mainstream conservative thought.)  On it's own, this could not sustain itself politically, so conservatives pull out their practical side and "privatize" it in ways that make conservative politicians and influences very wealthy.
       

  •  Does that include tax expenditures for insurance (0+ / 0-)

    provided by employers? That tax break is a coupla hundred billion dollars a year.

    HEY COGNITIVE INFILTRATORS! I googled "confirmation bias" and Daily Kos raided my house! And and and smashed my hard drives! Ask CNN, it's all truthy!

    by Inland on Mon Sep 23, 2013 at 02:38:20 PM PDT

  •  Lots Of Corruption In Canadian Medicine (0+ / 0-)

    Conflicts of interest, stock marker shenanigans - all legal in Canada.   Without the influence of the UK and then American regulators, Canada would be a chilly version of Mexico.

    The main thing to remember is that Canada has similar levels of taxation as the US and almost no military (per capita we spend more just on ammunition).  You'd think the streets would be paved with gold.

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Tue Sep 24, 2013 at 07:28:31 AM PDT

    •  Ignorant (0+ / 0-)

      Who was in command in Afghanistan when the US took a powder and went to Iraq? Who lost as many soldiers per capita as US in Afghan conflict? What country supplied the commanding general for the Libyan campaign? Three guesses, first two don't count.

      "...stories of past courage can define that ingredient..... But they cannot supply courage itself. For this each man must look into his own soul." JFK Profiles in Courage " Ontario

      by ontario on Tue Sep 24, 2013 at 08:34:17 AM PDT

      [ Parent ]

    •  Canada runs balanced budgets (0+ / 0-)

      while we "borrow".

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