I wonder if they don't understand that they're signing their own death warrants.
This is a prescription for an insurance system failure.
I think this is just what the doctor ordered - insurance companies making themselves obsolete by costing more than the care itself.
Also, fuck Aetna.
This is what I wonder...
We have UHC obviously, which means that our insurance providers only provide extended health care (which differs from package to package obviously). My extended health care is paid for by the school board (or the government, really) and it costs 259 a month for my family plan extended health (covers prescriptions, ambulance, semi-private hospital room, unlimited physio, 12 massages a year, $350 in eyesight costs every two years, $400 for dietician, chiro, naturopath, podiatrist, etc, and $6000 lifetime max for fertility meds) and 129 a month for dental (1700 a year, most things covered at 80%). My copay is $30 for the year.
That is WAY less than what you guys pay, companies are screwing themselves.
On the other hand, the statements I get that indicate the amount charged versus the negotiated insurance cost are simply outrageous. I really hope to God no one is paying that much for the same service!
This is what kills me. When DH had his heart surgery and we had a billion bills (ok wh am I kidding, between my genetic cancer risks and a special needs kid, we get medical bills all the time) it was mind boggling. Some bills would be written down just a few cents. Other bills would be a 90% discount!?!? W.t.f.
If not for that I would happily do a catestrophic only plan.
Dh's employer is self insured but this is his first year so I don't have a lot of data. This year it went up like 7%, but that is only like 9$ a month, so I am not too worked up over it.
We have UHC obviously, which means that our insurance providers only provide extended health care (which differs from package to package obviously). My extended health care is paid for by the school board (or the government, really) and it costs 259 a month for my family plan extended health (covers prescriptions, ambulance, semi-private hospital room, unlimited physio, 12 massages a year, $350 in eyesight costs every two years, $400 for dietician, chiro, naturopath, podiatrist, etc, and $6000 lifetime max for fertility meds) and 129 a month for dental (1700 a year, most things covered at 80%). My copay is $30 for the year.
That is WAY less than what you guys pay, companies are screwing themselves.
I'm not a huge fan of the Canadian health care system (which should not be read as suggesting I'm a fan of the US health care system), but that is not "WAY" less than what we are paying for our insurance coverage. Also our insurance covers more things at a similar or higher reimbursement rate, and I say that as someone who is NOT a big fan of our current coverage.
I also have a lot of control over my health care choices. So I don't have to go through my PCP to get to, say, a pulmonologist. I just call the pulmonologist and make an appointment. My fertility coverage was covered the same as any other part of my insurance plan except that I could only do 3 (or 5, can't remember) IVF tries. My eye care is a yearly coverage but it looks like it covers more than yours. Like the exam is probably about $150 and then it also covers a percentage of the lenses and contacts as well as technically the contact solution, but I never bother to seek reimbursement for that. A dietician or podiatrist would be covered the same as any other doctor and I don't know what a chiro would be covered at because I haven't seen one since high school. I think natropaths are full of shit so I don't have a problem with insurance not covering that (flammable). My dental covers one exam every 6 months + one set of xrays a year, and then it covers 50% of orthodontia. Various procedures are covered at varying rates. Hospital rooms are private.
I guess this is what they talk about when they talk about rationing care. I'm not sure I have a problem with what is covered and the amount that is covered under your plan, but if I were paying $260 a month for that plan, I think I'd be kind of unhappy with it. It looks like there are a lot of OOP expenses, so it would add up pretty quickly. For example, $400 for a dietician would be two appointments. PTS had a lot of trouble with weight gain because of her heart condition and we had multiple visits with dieticians both in and out of the hospital. We would have blown through that $400 during her first surgery and she was only 5 1/2 weeks old...
Makes sense I guess...I just hear about a lot of people paying upwards of $800 a month for insurance. We don't pay for ours, our employer does, so I am happy with what I get, if I wanted more I could supplement it but I haven't had to pay out of pocket for anything other than some dental...and those amounts are PER PERSON on the family plan, so $400 for each person for dietician. I only met with mine once and it was $150, so I didn't even come close to my max. When I was single and had a single plan I hit the max on dental a couple of times but now that I get my $1700 plus DHs I don't hit it.
I know there is a huge difference when it comes to seeing specialists between here and the US...I do have to go to my GP to get referrals, including to fertility. I can't really speak for how long our wait times for things are compared to the US but I know we do have wait times...when I needed an MRI the wait was brutal and had it been for something life threatening I would have gone to Buffalo to get it done, but my tumour wasn't going to kill me, waiting was just a PITA.
I certainly didn't mean to imply that our system was better (although I love my UHC) more that I would imagine that the insurance business here looks a lot different than in the US.
IME, MRIs are a same day thing. At least they were for both h and me.
I also have to say at this point, that my big defense of US health care came during the prenatal testing that was done on PTS. I had a structural ultrasound that showed the heart defect. THAT AFTERNOON I was sitting in an office with a specialist in fetal echocardiograms and had a diagnosis of her condition PLUS a birth plan by the time I went home. A week later, I was getting an amnio, and 14 days later, I had a complete genetic profile of PTS. A month after diagnosis, I was meeting with the doctor who would be performing her surgery after birth.
Obviously, none of that was "free." We hit our deductible and OOP max that year before even showing up for the delivery. But my understanding is that that process in Canada would have looked very very different. And emotionally, that would have been devastating for me. Especially because the first impression of the perinatologist who looked at the first u/s, was the PTS had a heart condition incompatible with life. The time between the perinatologist and the fetal echo was the longest 5 hours of my life. I can't imagine if it had been a weeks long process. How is Canada's mental health coverage? LOL!
I don't know how long your specific process would have taken here tbh but it is possible that it would have taken longer here than you waited. I realize that's an aspect to UHC that people don't like. I didn't like waiting for an MRI. It is likely because I have never really known anything else (well, except for when I lived overseas) that I don't mind. I do know that when my mom had an x-ray that showed a mass in her lung there was an aspiration done on a Friday night, she saw an oncologist on the Monday morning and started chemo on Wednesday. By our standards that's pretty fast. But, I also know that my father being a physician helped because he knew how to navigate the system and advocate for what needed to happen, not everyone has that. And my parents have no extended health care, their only cost was about $750 a month for her at home meds.
I do prefer the UHC because even though in the American system I would be better off because I have a stable job, I like that everyone here gets the same service regardless of whether or not they have a job or not or what kind of job. I don't think I could handle people going into debt for 100s of thousands of dollars for cancer.
IME, MRIs are a same day thing. At least they were for both h and me.
I also have to say at this point, that my big defense of US health care came during the prenatal testing that was done on PTS. I had a structural ultrasound that showed the heart defect. THAT AFTERNOON I was sitting in an office with a specialist in fetal echocardiograms and had a diagnosis of her condition PLUS a birth plan by the time I went home. A week later, I was getting an amnio, and 14 days later, I had a complete genetic profile of PTS. A month after diagnosis, I was meeting with the doctor who would be performing her surgery after birth.
Obviously, none of that was "free." We hit our deductible and OOP max that year before even showing up for the delivery. But my understanding is that that process in Canada would have looked very very different. And emotionally, that would have been devastating for me. Especially because the first impression of the perinatologist who looked at the first u/s, was the PTS had a heart condition incompatible with life. The time between the perinatologist and the fetal echo was the longest 5 hours of my life. I can't imagine if it had been a weeks long process. How is Canada's mental health coverage? LOL!
I think that's where you really see the gap between those with access to quality healthcare and those without. If you have access to good insurance and/or the ability to pay for it, you can receive absolutely excellent care in the US, probably better than anywhere else in the world (well, as long as you're in a major city, or rather, in some specific major cities). I've received really outstanding care, but I have decent insurance and access to some of the best hospitals and medical centers in the nation.
But if you didn't have insurance, would you have even gotten that structural ultrasound at all? If you were paying OOP and couldn't afford it, you may have even skipped it entirely and then been totally taken by surprised when she was born with a CHD. And then what kind of treatment options would you have for her without insurance? I can't imagine being hit with both "oh my god my child has a heart defect' AND "oh my god how am I going to pay for this?" within hours after giving birth.
ETA I know I'm preaching to the choir here - the whole system just horrifies and appalls me so much.
I don't know how long your specific process would have taken here tbh but it is possible that it would have taken longer here than you waited. I realize that's an aspect to UHC that people don't like. I didn't like waiting for an MRI. It is likely because I have never really known anything else (well, except for when I lived overseas) that I don't mind. I do know that when my mom had an x-ray that showed a mass in her lung there was an aspiration done on a Friday night, she saw an oncologist on the Monday morning and started chemo on Wednesday. By our standards that's pretty fast. But, I also know that my father being a physician helped because he knew how to navigate the system and advocate for what needed to happen, not everyone has that. And my parents have no extended health care, their only cost was about $750 a month for her at home meds.
I do prefer the UHC because even though in the American system I would be better off because I have a stable job, I like that everyone here gets the same service regardless of whether or not they have a job or not or what kind of job. I don't think I could handle people going into debt for 100s of thousands of dollars for cancer.
That's assuming they have any assets to leverage and can get a loan. Which is the HUGE problem with US health care. People here die because they don't have insurance. They die of lung cancer and child birth and all kinds of awful things that are inexcusable. I would bet that if you took the population of people in this country without insurance (like not even medicaid) so basically the working poor, their health outcomes would be similar to people in fucking third world countries. It's horrifying.
But... if you have insurance... And the uninsured poor are only like 3% of the population or something. I mean, what's a little death?! /sarcasm.
Yep, essentially, this. I realize my healthcare isn't actually as awesome as it could be, but at least it's equitable...I know I would feel differently if I were in the middle of a huge crisis and I had a horribly ill child and felt like I wasn't getting quality care fast enough, I get that, I am lucky enough to not have been in that situation (yet).
asdfjkl I think in your situation, you would have seen the appropriate specialists quickly. Perhaps not same day, but within a few days. Where the Canadian system lags the most is for things that are necessary but not necessarily urgent, if that makes sense. Fr example, rugbywife and the MRI. Hip replacements, hemrhoid treatments, non-cancerous tumours are a few things I've had family members complain about the wait.
I think our doctor shortage is the other big issue, obviously.
I wish there was some magical solution that would give both countries better health care
asdfjkl I think in your situation, you would have seen the appropriate specialists quickly. Perhaps not same day, but within a few days. Where the Canadian system lags the most is for things that are necessary but not necessarily urgent, if that makes sense. Fr example, rugbywife and the MRI. Hip replacements, hemrhoid treatments, non-cancerous tumours are a few things I've had family members complain about the wait.
I think our doctor shortage is the other big issue, obviously.
I wish there was some magical solution that would give both countries better health care
I don't mean to nit-pick but "a few days" when you've been told that your baby may have a condition incompatible with life outside the womb is really not good enough. And then I think of all the things that when with that. The dieticians, the the speech therapists (for her oral aversion), that kind of stuff.
Perhaps, but the difference here is that everyone has access to it with a few days wait time, regardless of their job, socio economic level or access to insurance. For me that matters.
IME, MRIs are a same day thing. At least they were for both h and me.
Not for me. I had to wait three days to get an MRI in my city (approx. 175K people). Now part of that wait time was also because the hospital wouldn't allow me in the machine without the pre-authorization from my insurance since I had an HMO at the time.
I don't mean to nit-pick but "a few days" when you've been told that your baby may have a condition incompatible with life outside the womb is really not good enough. And then I think of all the things that when with that. The dieticians, the the speech therapists (for her oral aversion), that kind of stuff.
Perhaps, but the difference here is that everyone has access to it with a few days wait time, regardless of their job, socio economic level or access to insurance. For me that matters.
Yep, this. I don't discount how awful that was for you asdfjkl, but how about the people who would never have had that care at all? The dieticians, speech Therapy etc would all be provided here, and again, to everyone in that situation not just those with $$ or good insurance.
Yep, this. I don't discount how awful that was for you asdfjkl, but how about the people who would never have had that care at all? The dieticians, speech Therapy etc would all be provided here, and again, to everyone in that situation not just those with $$ or good insurance.
The only people here who wouldn't have that care at all would be the working poor without insurance. Someone on medicaid would have that care. And under rugbys insurance she would have exhausted her coverage on some of that care long before she exhausted her need for it if she were in my situation. So in terms of motivating Americans to move to a Canadian-like situation, that's going to be very difficult because it's going to worsen the situation for so many in order to improve it for so few. Because the stakes are so high where healthcare is concerned, it is simply unconscionable to tell those un and underinsured that they have to deal with the status quo. But I do not think that a Canadian situation is the answer. It just trades one set of problems for another. That is why I like the public option idea. If people want Canadian health care in the US, they can opt in. If they're happy with what they have, they can keep it. But then, that doesn't really address the insurance companies themselves which seen hell bent on pricing themselves out of existence in the next decade.
I don't understand what care I would have exhausted if I were in your situation...none of what you received was covered under our extended health care, it's covered under UHC. Even things like Speech Path and OTs, that stuff is covered for children until they are in school. Then it gets don't through the school system. But yes, I agree, there would be a lot of resistance to worsening the situation of many in order to improve the few - do people on medicaid get the same level of care as you though?
In terms of opting in and opting out...it only works if everyone pays into the system by way of taxes. Part of the problem in the US, as far as I can tell, is that because a huge portion of the population makes so little, they don't pay taxes. The people who need to be paying into the system wouldn't be because their circumstances wouldn't require them to need UHC, they, like you, would be happy with the what they had, so unless they are paying into the system regardless, it wouldn't work.
Yep, this. I don't discount how awful that was for you asdfjkl, but how about the people who would never have had that care at all? The dieticians, speech Therapy etc would all be provided here, and again, to everyone in that situation not just those with $$ or good insurance.
The only people here who wouldn't have that care at all would be the working poor without insurance. Someone on medicaid would have that care. And under rugbys insurance she would have exhausted her coverage on some of that care long before she exhausted her need for it if she were in my situation. So in terms of motivating Americans to move to a Canadian-like situation, that's going to be very difficult because it's going to worsen the situation for so many in order to improve it for so few. Because the stakes are so high where healthcare is concerned, it is simply unconscionable to tell those un and underinsured that they have to deal with the status quo. But I do not think that a Canadian situation is the answer. It just trades one set of problems for another. That is why I like the public option idea. If people want Canadian health care in the US, they can opt in. If they're happy with what they have, they can keep it. But then, that doesn't really address the insurance companies themselves which seen hell bent on pricing themselves out of existence in the next decade.
It isn't just the working poor here who would be in that position, but those who don't have insurance through their employer and can't get individual insurance because of a pre-existing condition. I know quite a few people in this position and I rarely see it mentioned when the problems with our system are discussed.
Congress has been more interested in keeping/growing their contributions to get reelected than working on solving our jobs/economic problems or any other problems.
The article in the OP came off a bit like a scare tactic and doesn't really go into why some consumers will see an increase in their HC premiums due to the ACA. There are many regulations that insurers will now have to follow including decreasing the disparity between how much they can charge someone who is elderly, high risk, female vs a young healthy male. Currently someone can be charged 7x as much for the same policy just because they are higher risk or have a uterus. Will it suck for the young men who are used to paying low premiums? Yes, but it'll be great for others who will see their premiums go down. There are tax subsidy options for up to 4x the poverty level (I believe that the Republicans are trying to lower this to 3x) and also other options such as the ability to buy just catastrophic insurance if you meet certain criteria.
This bill is so complicated and nuanced that it's hard for most people, even experts, to understand. But scare tactic articles that cause a knee jerk reaction aren't helping to educate people on the actual facts of the law. (This semi rant is coming from a weekend in which my FB feed was full of 'poor people are sucking the system dry and eating lobster and steak at every meal').
asdfjkl - I think, understandably, you are confused as to what would be covered by UHC and what wouldn't be. A lot of things are covered under UHC, especially for children.
But anyway, I agree that the Canadian system might not work in the US. We have higher taxes, and so a sort of 2-tiered system as you suggest probably wouldn't work without a tax increase in the US and we all know that wouldn't get the political support. As caden and I have discussed before, the innovation for many health care breakthroughs come from the US and there MAY not be the incentives in a single-payer system (its hard to say for sure though as we've had a decent # of healthcare advances ourselves, as have many European nations).
I don't think there is a 'right' answer for either country. But I think both countries can do better, and could probably learn from each other. Of course I'm a staunch supporter of UHC largely because of the 'fairness', and because I think insurance companies are the devil, but thats not to say that in some situations the US system isn't best. In your daughters case, it was obviously great. It just bugs me that for 50% of the US population, that care probably wouldn't have happened.
As caden and I have discussed before, the innovation for many health care breakthroughs come from the US and there MAY not be the incentives in a single-payer system (its hard to say for sure though as we've had a decent # of healthcare advances ourselves, as have many European nations).
youre sort of conflating 2 issues (production and consumption). It's not that research or medical breakthroughs can't happen elsewhere, it's that global R&D would suffer drastically if the US adopted strict price controls bc so much global R&D is done to make a profit in the US. We basically subsidize many other countries so everyone can continue to benefit from expensive, risky medical breakthroughs. That said our R&D is pretty awesome. But that's a slightly different issue.
It isn't just the working poor here who would be in that position, but those who don't have insurance through their employer and can't get individual insurance because of a pre-existing condition. I know quite a few people in this position and I rarely see it mentioned when the problems with our system are discussed.
You mean the un and under insured? Like people who work for Walmart making minimum wage as part time employees who don't qualify for insurance? That's what I'm talking about when I say the working poor.
I meant that in addition to the working poor, there are those who can't get individual insurance due to a pre-existing condition. Even if they have the money to pay for insurance, they can't buy it because no one will insure them. So, the problem isn't limited to the working poor, but to those who are self employed too.
asdfjkl - I think, understandably, you are confused as to what would be covered by UHC and what wouldn't be. A lot of things are covered under UHC, especially for children.
I am responding to Rugby who explained pretty specifically what her Canadian UHC/Insurance covers. That insurance is worse than what I have (especially if you add in the wait times) and if it is typical of Canadian health care coverage then my point stands with regard to trading one set of problems for another and wanting to worsen the position of many people to help the position of a few.
As I said, because the stakes are so high, it is not acceptable for there to be people who cannot afford good health care, but the Canadian system just trades one set of problems for another.
rugbywife mentioned HER coverage, for an adult. Children have a lot more covered by UHC that adults don't (optometry, dental, speech therapy, etc). I don't know whether your daughter would have recieved the same care here as far as how FAST her service was I just wanted to clarify that she would have still recieved all the incidentals, for free.
You mean the un and under insured? Like people who work for Walmart making minimum wage as part time employees who don't qualify for insurance? That's what I'm talking about when I say the working poor.
I meant that in addition to the working poor, there are those who can't get individual insurance due to a pre-existing condition. Even if they have the money to pay for insurance, they can't buy it because no one will insure them. So, the problem isn't limited to the working poor, but to those who are self employed too.
Right, this is a huge issue. There are people that are afraid to start their own business for lack of health insurance or access to it on an individual basis. In addition there is a growing pool of people who are classified as "independent contractors" - now many of these are the working poor, such as those working in warehouses fulfilling your orders for amazon.com, but they are also lawyers doing doc review in a windowless basement.
asdfjkl - I think, understandably, you are confused as to what would be covered by UHC and what wouldn't be. A lot of things are covered under UHC, especially for children.
I am responding to Rugby who explained pretty specifically what her Canadian UHC/Insurance covers. That insurance is worse than what I have (especially if you add in the wait times) and if it is typical of Canadian health care coverage then my point stands with regard to trading one set of problems for another and wanting to worsen the position of many people to help the position of a few.
As I said, because the stakes are so high, it is not acceptable for there to be people who cannot afford good health care, but the Canadian system just trades one set of problems for another.
Oh, I explained why my extended health care covers...I don't know if I was explicit that whatever isn't covered by my extended health care is actually covered by our UHC. I don't have a lot of experience with the specific issues that your daughter faces but most of what I did gather led me to believe that it would have been dealt with under UHC. Essentially, if we go to the hospital, it's covered, if we see a doctor, it's covered, if we need a diagnostic test, it's covered. What isn't is our medications, dental, eye care and some other stuff (naturopath, dietitian, physio, massage)...when I described my insurance it was to cover that stuff.
But I totally get your idea about trading one set of problems for another...I know a lot of people here can find the wait times annoying. My father (a physician in Quebec) firmly believes in a two-tiered system (which exists there and in Alberta) but I really don't know enough about it speak it how effective or ineffective it is in comparison to other systems.
I think you would have had all the exact same care at the time of birth for sure (I know this because my father was a neonatologist at a Tier 3 hospital for most of my life), all the NICU stuff, scans, all that.
Nothing like that is rationed. You don't pay premiums for UHC, you, or your employer, pay premiums for extended health and dental, the services listed in my last post, many of which are provided fee of charge for children. The only test I can think of that you listed that there might have been a wait time on was the the second one you got, after they identified the initial problem. But honestly, when a baby is at risk, I usually hear about quick results. I will ask my SIL what her timelines were line when my nephew was diagnosed with a mass in his lungs in utero. I know he was treated at the local Children's hospital.
asdfjkl - just sent what you asked to my girlfriend who is a pedi nurse at a Children's hospital. Yes, everything you received would have been 100% covered under UHC, including the dietician. And we don't have an abortion cut off date, FYI.
Look, I don't think for one hot second that we have the best health care in the world up here. But it really annoys me when people assume we have rationed or sh!tty care. We don't.
asdfjkl - just sent what you asked to my girlfriend who is a pedi nurse at a Children's hospital. Yes, everything you received would have been 100% covered under UHC, including the dietician. And we don't have an abortion cut off date, FYI.
Look, I don't think for one hot second that we have the best health care in the world up here. But it really annoys me when people assume we have rationed or sh!tty care. We don't.
The google tells me it varies from hospital to hospital but is between 20-24 weeks not because of the Canadian Health Act but because of some kind of hospital licensing laws up there? And that it is covered by some provincial insurances but is not covered through "reciprocal billing" so if you live in a province that covers it and want the procedure done in a province that doesn't, you can't get it covered. It actually looks like the situation with abortion is in Canada is pretty similar to that in the United States with the exception that in those provinces where it is covered, it is "free."
FTR: I don't think Canada has shitty care. And I've stated that repeatedly. I do think it has rationed care. Because it does. And I don't think there is necessarily anything wrong with that. We should have some rationed care here. Especially in the Medicare arena (DEATH PANELS). But I do not accept that Canadian-style health care is the answer to the US healthcare crisis. It answers some problems, but creates others. It helps some, while it hurts others. And it does nothing to address the big underlying problems with US Health care which is that we're living longer, but not healthier.
You're talking about elective abortion. In a situation where the fetus/baby is facing something that is "incompatible with life", or obviously where the mothers life is in danger, there isn't really a cut-off. It DOES vary between the provinces though so I can only speak for Ontario, I should have been clear on that. I don't think PEI has abortion facilities.
We probably ration care for the seniors, but when it comes to kids, everything is urgent. IIOY would love to watch the olds wait in line for their hip replacement
Yeah, our coverage had better darn well be good. I'm a Fed and when you combine our share with the gov. share for our family health plan, the insurance company is charging $900/month for a very healthy family of four. We have Coventry now, but I just checked the price on our previous plan with Aetna and they now charge $1200/month. And that's for their "basic" plan, not the "high" one.
Considering that the Federal government provides the largest insurance pool in the country, the fact that they are getting hosed this badly providing federal workers coverage does not bode well for the future of private health insurance in this country.