Simple numbers for simple people...
Oct. 20th, 2010 10:37 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
I've heard people rant about the evils of "socialist" medicine - the high taxes, the long waits, etc.
Well, for any of my fellow Americans who have needed health care, you KNOW that the waits are pretty damned long around here. You've probably also experienced the ugly side of billing - that your insurance certainly NEVER covers everything, and that even with decent insurance, you're going to spend a small fortune.
But let's look at cost. Nothing but cost. Here's a REPORT from CNN Money:
"Employees' share of premiums for a family plan is up an average 14%, to $3,997, vs. just a 3% rise in the total bill, according to the Kaiser Family Foundation."
So... our share of the insurance cost is rising, the actual insurance cost is rising, and simultaneously, our co-pays, co-insurance, and deductibles are also rising. In 2009, the average cost of healthcare, per capita, in the United States was $8,047. And as a nation, we spent 17.3% of our entire gross domestic product on health care! That's fucking INSANE.
Wow... Canada spent an average of $4,089 per capita in 2009 on health care. And that's TOTAL! Not "insurance"... TOTAL. And that's about 10% of their GDP.
Why is this so fucked up? Overhead, partially. Inefficiency, partially. Americans who don't take care of their own health, partially. But LARGELY because after the insurance premiums in America are paid... we keep paying. Oh yes. THROUGH THE FUCKING NOSE. Have you ever gotten sick? Gone to the ER? Gotten a bill in the mail for thousands of dollars? Had to take out a loan, set up a payment plan, or sell a possession to afford health care? Even with insurance, we keep paying. And paying. And paying. Co-pays, co-insurance, deductibles, and so on.
I've got damned good health insurance... for an American. I still pay $100 to go to the ER. $25 to see my PCP. $45 to see my rheumatologist, cardiologist, ophthalmologist, dermatologist, ob/gyn, and neurologist. Don't laugh - this shit could happen to anyone. I've always been an athlete and if most American ate a diet like mine, we'd solve the type-2 diabetes crisis and turn the heart disease statistics upside down. I don't smoke and I seldom drink. And I STILL got sick. And every time they say, "You need to have ___ checked by ____ specialist," there goes another $45, minimum.
So... for my insurance alone, I just found out that the base cost to my employer (who pays 95% of my premium) is $5,760 per year. That means if I NEVER get sick, I'm automatically costing $5,760 per year. Think about that. It's part of my employee benefits, so it's mine - and it means that I'm effectively shelling out that much before I even see a doctor. Wow folks, that's ALREADY over what Canadians spend per capita. My income is almost exactly average for an American. Oh, and of course, I pay taxes. My taxes cover all those people who can't pay for medical care because our economy sucks and people are losing their jobs or are under-employed. So on top of my premium, and all the co-pays and co-insurance and deductibles I pay, I'm also paying in taxes.
Right now, spending a direct, average amount of $4,089 sounds pretty damned CHEAP, doesn't it? And with longer life expectancies and lower infant mortality rates, that means the Canadian plan is more effective, too.
Oh, and when all is said and done... have any of you ever had to fight with an insurance company for approval, or a claim that got denied, or simply the filing process itself? Keeping track of all that paperwork can be pure hell, on top of already feeling like shit.
So why are we still trapped in our insurance-based system?
EDIT: I mis-read something in the CNN article, and I am changing a paragraph to reflect what I realize it actually meant.
EDIT AGAIN: Another objection I often see to UHC is about the right of the doctors to earn a profit. What's a profit, I ask? It's a paycheck, right? Adjusted for the exchange rate at the time this chart was posted, all based on 2005 data (recent enough for argument, as far as I'm concerned):
Well, for any of my fellow Americans who have needed health care, you KNOW that the waits are pretty damned long around here. You've probably also experienced the ugly side of billing - that your insurance certainly NEVER covers everything, and that even with decent insurance, you're going to spend a small fortune.
But let's look at cost. Nothing but cost. Here's a REPORT from CNN Money:
"Employees' share of premiums for a family plan is up an average 14%, to $3,997, vs. just a 3% rise in the total bill, according to the Kaiser Family Foundation."
So... our share of the insurance cost is rising, the actual insurance cost is rising, and simultaneously, our co-pays, co-insurance, and deductibles are also rising. In 2009, the average cost of healthcare, per capita, in the United States was $8,047. And as a nation, we spent 17.3% of our entire gross domestic product on health care! That's fucking INSANE.
Wow... Canada spent an average of $4,089 per capita in 2009 on health care. And that's TOTAL! Not "insurance"... TOTAL. And that's about 10% of their GDP.
Why is this so fucked up? Overhead, partially. Inefficiency, partially. Americans who don't take care of their own health, partially. But LARGELY because after the insurance premiums in America are paid... we keep paying. Oh yes. THROUGH THE FUCKING NOSE. Have you ever gotten sick? Gone to the ER? Gotten a bill in the mail for thousands of dollars? Had to take out a loan, set up a payment plan, or sell a possession to afford health care? Even with insurance, we keep paying. And paying. And paying. Co-pays, co-insurance, deductibles, and so on.
I've got damned good health insurance... for an American. I still pay $100 to go to the ER. $25 to see my PCP. $45 to see my rheumatologist, cardiologist, ophthalmologist, dermatologist, ob/gyn, and neurologist. Don't laugh - this shit could happen to anyone. I've always been an athlete and if most American ate a diet like mine, we'd solve the type-2 diabetes crisis and turn the heart disease statistics upside down. I don't smoke and I seldom drink. And I STILL got sick. And every time they say, "You need to have ___ checked by ____ specialist," there goes another $45, minimum.
So... for my insurance alone, I just found out that the base cost to my employer (who pays 95% of my premium) is $5,760 per year. That means if I NEVER get sick, I'm automatically costing $5,760 per year. Think about that. It's part of my employee benefits, so it's mine - and it means that I'm effectively shelling out that much before I even see a doctor. Wow folks, that's ALREADY over what Canadians spend per capita. My income is almost exactly average for an American. Oh, and of course, I pay taxes. My taxes cover all those people who can't pay for medical care because our economy sucks and people are losing their jobs or are under-employed. So on top of my premium, and all the co-pays and co-insurance and deductibles I pay, I'm also paying in taxes.
Right now, spending a direct, average amount of $4,089 sounds pretty damned CHEAP, doesn't it? And with longer life expectancies and lower infant mortality rates, that means the Canadian plan is more effective, too.
Oh, and when all is said and done... have any of you ever had to fight with an insurance company for approval, or a claim that got denied, or simply the filing process itself? Keeping track of all that paperwork can be pure hell, on top of already feeling like shit.
So why are we still trapped in our insurance-based system?
EDIT: I mis-read something in the CNN article, and I am changing a paragraph to reflect what I realize it actually meant.
EDIT AGAIN: Another objection I often see to UHC is about the right of the doctors to earn a profit. What's a profit, I ask? It's a paycheck, right? Adjusted for the exchange rate at the time this chart was posted, all based on 2005 data (recent enough for argument, as far as I'm concerned):
Specialty | US Average Salary | Canada Average Salary (n/1.212) |
Family Medicine | $164,952 | $167,064 |
Int. Medicine | $170,889/ $169,450 (hospitalist) | $248,721 |
Ob/Gyn | $253,160 | $261,412 |
Gen. Surgery | $278,433 | $247,375 |
Anesthesia | $309,019 | $205,441 |
Urology | $317,778 | $279,982 |
no subject
Date: 2010-10-20 03:49 pm (UTC)In Ireland I had to pay €50-€60 every three months for my Doc to write me my contraceptives prescription, then the stuff itself cost €14. Here in England, I pay zero for both visit and medicine! Yay!
Neither country is remotely socialist either, it's just that civilized countries treat healthcare as a right for all.
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Date: 2010-10-20 03:53 pm (UTC)no subject
Date: 2010-10-20 03:57 pm (UTC)no subject
Date: 2010-10-20 03:56 pm (UTC)I know that most of the folks who read my LJ are on the same general bandwagon, but I needed to rant today. I just signed up for my health insurance for next year (without it, I'd be completely fucked), and realized that I was worried about how much money I'd STILL be paying AFTER the premiums were paid. We pick our health plans based on which ones will leave us the least bankrupt if we get sick.
I have a cardiologist appointment today. That's another $40 out of pocket, just for walking in the door. Next year, it'll be $45.
no subject
Date: 2010-10-20 04:07 pm (UTC)As a Brit, the mentality of thinking that medical insurance is better than free healthcare is utterly bizarre to me. I honestly can't see one logical reason why somebody would believe that.
(But then, the right-wing American stance in general tends to make no sense to me and probably to most people in the UK. Handguns as a civil right? Huh?)
In the past few weeks, I have paid five separate visits to my doctor. I have been to my dentist. I have a dermatology appointment next week. I have had a flu jab and two prescriptions. The only things from that list I've paid for were the dentist appointment and the prescriptions, and they were all pretty cheap. I didn't have to fill in any insurance forms or make any claims. I'm not even ill. My family members are - my mother's in remission from cancer (and has had countless appointments, inpatient stays, medications, treatments and even wigs provided for free by the NHS), my sister has ME, etc. Nobody can tell me that medical insurance (which we'd struggle to even pay for to be honest) would provide a better service than the NHS.
To me, healthcare should be a basic human right. Maybe not absolutely everything available on the NHS would count as a human right, but when something's medically necessary it should be as much a right as the rights to food, water, shelter and clothing.
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Date: 2010-10-20 04:13 pm (UTC)I don't care what the cost is, how many nights I cry myself to sleep or how long I have to quarantine my cat. I am gone, and may this country get exactly what it deserves!
Barbara Havers thinks this shit is stupid.
no subject
Date: 2010-10-20 04:18 pm (UTC)I wish I really had a good answer for that.
My cardiologist alone is a $40-$50 co-pay (it seems to change), and god forbid you don't have it - it's a $300 visit straight up. With my heart issues, I have to see him 2-3 times per year. More if there's something going on.
I'm frustrated.
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Date: 2010-10-20 04:19 pm (UTC)I mean of course we pay as well. We pay through our taxes and national insurance payments, however we will always get treated and have no extra sudden cost added in. If you are not working, on benefits you will get the same treatment too. There is no extra benefit to being wealthy when using the NHS. Everyone is treated the same. Naturally people who can afford private healthcare will use that as well. It is their choice.
The NHS is not perfect of course. They are always problems somewhere along the line and dentist treatment on the NHS can be a joke at times. Most people stay private for dental treatment, I do but there is good plans out there!
But the main gist of your point is interesting. Calling it the health care of socialism creates these terrible images in the heads of some Americans because of apparent associations with communism! It is a scare tactic of course and like you say, socialised medicine is not socialism. It is something for a civilised society.
no subject
Date: 2010-10-20 04:23 pm (UTC)Because the insurance industry is about making money (which they do - a lot!) rather than taking care of people.
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Date: 2010-10-20 04:37 pm (UTC)no subject
Date: 2010-10-20 04:49 pm (UTC)Certainly there are problems with the NHS. I defy you to find any business or institution the size of the British National Health Service that doesn't have some problems, regardless of whether it's run by the government or private companies. There's problems with bureacracy, lack of funding, people making the wrong decisions. There are people who can't get the medication they need from the NHS because it's too expensive, or who have to wait in huge queues for treatment.
But you know what? Many of those things are so rare in the UK that they make the national news.
Yes, we pay. The money for the NHS doesn't come out of nowhere. But people who can't afford to pay taxes still get free treatment (unlike medical insurance). And people who do pay taxes (and "national insurance") pay (I believe, and certainly the post above suggests) an awful lot less than Americans tend to pay to insurance companies.
no subject
Date: 2010-10-20 04:49 pm (UTC)There are tons of comparisons of quality of the Canadian system vs. the American system, and Canada WINS in almost EVERY CATEGORY. The only category where they don't beat the pants off the USA is in cancer treatment.
Trust me, there's a wealth of data out there - wait times, patient outcomes, accessibility of care, total cost.
While you wait and see, people are going bankrupt for their health care in the USA, or being turned away because they lack health insurance. How long do you want to wait? The data is already available.
Hi! Canadian here.
Date: 2010-10-20 05:43 pm (UTC)And here's Ontario: http://www.rev.gov.on.ca/en/tax/healthpremium/rates.html
As you can see, pretty cheap. The Medical Services Plan (MSP) provides the following benefits:
•medically required services provided by a physician enrolled with MSP;
•maternity care provided by a physician or a midwife ;
•medically required eye examinations provided by an ophthalmologist or optometrist;
•diagnostic services, including x-rays and laboratory services, provided at approved diagnostic facilities, when ordered by a registered physician, midwife, podiatrist, dental surgeon or oral surgeon;
•dental and oral surgery, when medically required to be performed in hospital*;
•orthodontic services related to severe congenital facial abnormalities.
The following are not automatically covered, or have limited coverage (by the Govt):
•Acupuncture;
•Chiropractic;
•Massage Therapy;
•Naturopathy;
•Physical Therapy; and
•Non-surgical Podiatry.
These are where your employment plans would kick in, or the like.
Is the system perfect? No.
Do people with non-life threatening conditions have to sometimes wait for services such as surgery? Yes. Can they bypass the wait and pay for private services, in Canada or elsewhere? Yes.
Is all surgery paid for? No. If you don't 'need' it, according to you doctor, you don't get it paid for. Examples of this would include plastic surgery that is cosmetic only.
Do you have to pay for your own prescriptions? Most of the time, unless you are on social assistance, are elderly, or have benefits from your employer, or a group plan that you pay extra for.
Exceptions to this rule are medications given in hospital - such as cancer treatments. However, you may have to pay for some home medications during the process.
I've been lucky to have never suffered major illness or injury, I've had the following (off the top of my head), in my lifetime, covered by MSP: tonsils removed, wisdom teeth removed, leg cast for dislocation, pneumonia a few times, migraine treatments, including neurologists, cat scans and mri's, many ER visits due to all of the above, annual & bi-annual check ups including specialists, and all blood tests, pap smears, et al. I had free eye exams until my mid 30's, now I have to pay and be reimbursed by my employer ($80 each, once every 2-4 years - I have perfect eyesight, so yay me). The young, old and medically necessary still get them for free, as do those on social assistance.
We've had some major medical conditions in my family, however, including Type-1 diabetes, heart conditions and cancers. No bills. Some costs associated, such as the diabetes glucose tests strips, though the insulin & pump is free/paid for by the government.
Anyways, as I always say, good luck to you all, hopefully the fear of the unknown loses the war over reason.
Re: Hi! Canadian here.
Date: 2010-10-20 06:01 pm (UTC)Just tell everyone who's arguing against it what you just told me, and maybe the USA will have intelligent health care before the next century.
no subject
Date: 2010-10-20 04:38 pm (UTC)And the arguments against socialized medicine are outrageous. "Oh, we can't pick our own doctors." Bullshit. Your insurance company makes you pick from their list or ASSIGNS you a doc--so what's the difference here? "We'll have to wait months for surgery or appointments." Obviously, they've never tried to get an appointment with a specialist or a surgeon lately.
Like you, I have good insurance. It paid for all my well checks (except for the $30 co-pay), my mammogram and follow-up ultrasound. But I'm also paying $500 out of pocket per month for the premium. I have great doctors. I have a level 1 trauma center 10 minutes from my house. But I'm ready for this country to change.
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Date: 2010-10-20 04:55 pm (UTC)There's a certain amount of choice in the British NHS. I could pick any G.P. within a certain distance from my home. Upon getting a referral to a dermatologist recently I was offered a choice of different hospitals or a local clinic.
And the waiting list argument makes little sense to me. How does how doctors are paid affect how many of them there are or how many people need to see them? (Other than perhaps the people without medical insurance deciding against bothering.)
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Date: 2010-10-20 05:03 pm (UTC)By the way, how does mental health care work in the US? Is that also covered by insurance or does that operate separately?
I work in a mental health clinic (admin) and I'm just curious as to what the difference would be.
no subject
Date: 2010-10-20 05:06 pm (UTC)no subject
Date: 2010-10-20 05:50 pm (UTC)But what is most impressive about Canada's healthcare was how they treated my uterine fibroids. I saw a doctor in Seattle about my extreme cramps and bleeding before leaving Seattle, said I was worried about endometriosis or some other condition, and could she check them out. I was dismissively told not to self-diagnose, and she wouldn't even send me for an ultrasound. Shortly afterwards, I moved to Canada, where I had to wait for 8 months before receiving medical coverage. Once I got it, I saw a doctor who immediately scheduled an US and discovered that I had huge fibroids. Had they been caught earlier, I might have been able to reduce them with meds; as it was, I had to have a hysterectomy (which was free, btw, and done within three months). I can't help thinking that my US doctor didn't want to incur the costs of the ultrasound, so I was left undiagnosed.
So yeah. I'll take the Canadian system any day!
no subject
Date: 2010-10-20 05:57 pm (UTC)Then, in September, I found a new ob-gyn. Had a hysterectomy TWO WEEKS later. (Still recovering, actually.) However, my wait time was so short because A) the doctor was brand new to the hospital and her schedule hadn't filled up yet, and B) I work at the same hospital, so they squeezed me in. I'm sure my wait would normally be a few months.
However, if you find a sucky doctor in Canada, at least you're not paying for them out of pocket, and you can see another doctor who actually WILL treat you. And Canadian doctors seem to want to FIX things, instead of just bouncing you around for tests that seem to have no real purpose.
no subject
Date: 2010-10-20 07:03 pm (UTC)And if you're an "illegal" inmigrant, it's the same. You just need to get the card of the healthcare system (we call it Seguridad Social) and that's really, really easy. And then, you'll be attended every time you need it with no cost at all (except for the medecines).
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Date: 2010-10-20 07:34 pm (UTC)no subject
Date: 2010-10-20 10:28 pm (UTC)no subject
Date: 2010-10-21 12:27 am (UTC)I was in the hospital early this year for a kidney infection. What did I have to pay for? The ambulance ride. and I only had to pay 20% of that. I'm lucky that my school offers insurance that is included with our semester fees and that it is available to anyone who doesn't opt out. So basically, if you're at my college, you have health insurance for a low fee and can get dental 80-100%, perscription drugs 85% and ambulance 80% off. There are more but those are the ones that I remember.
It really is too bad that there are so many people who don't see how are system works, choosing to instead believe what they think they know.
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Date: 2010-10-21 12:27 am (UTC)no subject
Date: 2010-10-21 03:13 am (UTC)What drives them is the true relentless desire to solve medical problems and find cures and treatments for people. They don't give a shit about profit as long as they get paid a fair salary (because it's damned hard work - 70 hour weeks or more) for their knowledge and effort. And to be honest, researcher salaries are dirt-low anyway. They're in it because the scientific mystery drives them, as does the need to improve medical knowledge and techniques.
The nation would need to invest some of the health care budget into research... but it ALREADY DOES. And if the system weren't profit-driven, they'd be able to put more effort into finding cures for diseases that desperately need attention... and less into things like "viagara" because it can turn a profit. Research needs to go where the medical NEED is, not where the profit is. But right now, pharmaceutical research is profit-driven. I worked in an oncology lab for one of the biggest pharmaceutical companies in the world. Their drug development "pipeline" is insane.
Trust me, the USA has people who are curious, intelligent, and driven enough to keep improving medical technology. And also, improvements help keep down cost in the long run. If you could CURE a person with type-1 diabetes instead of keeping them on insulin for their whole life, it's cost-efficient, right? And it's better for everyone, especially the patient. Improved treatments for diseases reduce complications, which cost money.
So... even if a universal health care system was trying to minimize cost, it would still be in their best interest to keep pushing research forward. It would be in their best interest to keep good technology available.
And as I know from all of my Canadian friends and family (most of my family lives there), the quality of health care up there is excellent. High-tech, very advanced... just like the USA. They don't have as many MRI machines, but by and large, they've got everything we have, and they don't WASTE nearly as much money as we do.
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Date: 2010-10-25 08:44 pm (UTC)It could well be argued that socialised medicine provides a driver for ensuring costs are kept in check by discouraging waste so medicine needs to prove its worth. I know so many US friends who have loads of drugs thrown at them after miscarriage even 'though those dugs have little proven use in helping future pregnancies, while in the UK that just doesn't happen because there is an increasingly strong bais to evidence-based medicine. There are reasons that the Cochrane Collaboration is based in the UK and one reason is because our system of socialised medicine encourages doctors to discover and use the most effective remedies and practices.
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Date: 2010-10-25 09:05 pm (UTC)And you highlight the point that a lot of Americans seem to think that medical research in the USA is somehow isolated. It really is an international community, and innovation happens all over the world.
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Date: 2010-10-21 01:30 am (UTC)I would say that I don't know how anyone could read this and have any common sense could still argue about it, but I know from working on HCR that there are.
Don't get me started. I honestly considered marrying a Canadian guy friend, he offered, before I did the drastic means I did. I just couldn't do it because I'm lame like that and think marriage is to sacred.
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Date: 2010-10-21 02:36 am (UTC)This just...this sums up every reason why I, quite literally, thank God every day that I live in Canada. I look at news stories like this and it scares the shit out of me.
The fact of the matter is, I don't even know what's going on half the time with my health care. Because I don't NEED to worry about it. I don't have to count every penny and decide when I can go see a doctor and when I need to stick it out. I just...go. Yeah, I take the system for granted...but am I ever fucking grateful that I can.
/end Canadian thoughts
no subject
Date: 2010-10-21 03:19 am (UTC)But many, many valid points that even to the more conservative, make sense (and subsequently, are infuriating).
no subject
Date: 2010-10-21 03:36 am (UTC)See, I hate that health care has become a partisan issue. I want it to be a "what makes sense" issue. Currently, our "system" is in shambles. There are so many examples of universal health care systems that WORK, with better overall results than ours, and much MUCH lower costs than ours. We pay MUCH more per capita than ANY other nation in the world... and that's even when you average in all of our citizens who have no health care coverage, and who never see a doctor. It's all a matter of practicality. We waste so much money. Health insurance and big pharma skims so much profit off the top. It's just... illogical.
I'm not a democrat - I'm an independent. Usually a moderate. But when it comes to health care, I see NO logical argument for our current system over Canada's single-payer style of system. Sure, the system has its flaws, but so does ANY system with limited resources. Our system is limited, too... but unless you're rich or have amazing insurance, the limitations can be disastrous.
no subject
Date: 2010-10-21 04:55 am (UTC)Healtcare is double bind were I can't "win" for "losing". If I need health insurance I still have to pay and I don't need it well you showed the numbers on that pretty well.
I think more people need to go back to high school government class and revise the difference between socialism and communism. Yeah "socialist" healthcare isn't perfect but it makes more sense than the "capitalist" insurance-based healthcare that we're limping along with right now.
no subject
Date: 2010-10-25 08:54 pm (UTC)It saddens me when I read of the experiences of US women on the miscarriage comm who had had to endure D&Cs under locals because that's cheaper than generals, and who are still paying off the cost of their D&C at the time their due date would have been. And yet they would almost all claim that their healthcare was better than mine (even 'though I bet you they didn't get hot, sweet tea and hot buttered toast after their ops) because they have swallowed the myth that the US healthcare sysem is the best in the world rather than just the most expensive.
Miscarriage isn't the be all and end all by any means but it is symptomatic of the whole system.
no subject
Date: 2010-10-25 09:13 pm (UTC)Hot tea and hot buttered toast? That DOES sound lovely. Although I'll admit, the hospital where I had my hysterectomy has very tasty food, ordered and delivered room-service-style. I was quite shocked. (Too bad my pain level was uncontrolled because of poor nursing staff, and I had almost no appetite.)