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.
For an anecdote, this was me after I had a pulmonary embolism at age 23: I was told that I would not be able to buy individual insurance, ever, no matter what I was willing to pay. So it's not just the working poor; if I hadn't gotten a job with group health insurance I wouldn't be insured. That is a pretty frightening fact to face at 23 when you've recently been hospitalized for a life-threatening condition. (I wasn't married at the time so didn't have an option of coverage through a spouse.)
Likewise, my husband would not have quit working for his previous employer and started his own company (turning him into a job creator!) a couple of years ago if he had not been covered by my company's group plan.
Maybe we should try to get DHs company to move him to Calgary.
Moneysense says its the best place in Canada to live!!
Actually, fwiw, I *think* Alberta has a 2-tiered health care system. I know absolutely nothing about it, so I can't comment. Although my cousin is an MP there so I should call him and get the scoop.
This woman was sent over 300 mi to BFE montana (a town of <60K people) while in preterm labor with ID quads. Now hopefully by now the bad press has resulted in more NICU space. Meanwhile it illustrates how supply restriction, which is one of the only ways cost is contained in a UHC situation, results in rationing.
This woman was sent over 300 mi to BFE montana (a town of <60K people) while in preterm labor with ID quads. Now hopefully by now the bad press has resulted in more NICU space. Meanwhile it illustrates how supply restriction, which is one of the only ways cost is contained in a UHC situation, results in rationing.
Ok, while that situation is FAR from acceptable, that isn't rationing care. There was a SHORTAGE of beds/facilities for that extremely delicate situation, which is far different from rationing. Furthmore, the government paid for her care at the closest/best available facilities.
I'm going to go out on a limb and suggest the US gov't wouldn't pay for someone's care in Canada if it was going to be better.
THe situation you're referring to is more of what I discussed earlier about doctor shortage, which is certainly a very real issue here.
Post by SusanBAnthony on Mar 25, 2013 21:16:39 GMT -5
I can definitely get on the pre existing condition train. DH was an self employed engineering consultant before we moved here, but cobra was running out. One of us had to get a job with a big enough company to offer group insurance. And even with obamacare fully kicking in and supposedly not having épée existing conditions anymore,it scares the crap out of me to buy individual insurance. I tried to apply for them (even though I knew we would be rejected) when we were about to lose cobra, and you have to list every dr. Appointment for some number of years before the date of application. And you know the minute we actually had claims (hello cancer for me, kids have genetic conditions, open heart surgery for DH) they would have gone back and looked at what I submitted and found the 2 or 5 random trips to the dr. for a sinus infection and dropped us like a hot potato, leaving us declaring bankruptcy with 200k of medical bills after DH's surgery.
Maybe that will no longer happen under obamacare, but until we have a few years of data, I don't trust individual health insurance for a minute.
The doctor shortage and bed shortage is a form of rationing. It's happening bc there isn't enough money to pay for everything that is needed. So some of the money that needs to go to improved facilities and physicians is used elsewhere to meet other needs deemed to be higher priorities. It's supply restriction bc demand is uncontrollable. Wait times are another type.
And my insurance would pay for my medical treatments at a non-local hospital if no local hospital was available. I know this bc we had to have stuff done at Mayo when no one here was able to do certain tests my DS1 needed. I'm with SBP in that I don't think Canada's hospitals are super shitty, but that we don't want your problems any more than we want our own.
The doctor shortage and bed shortage is a form of rationing. It's happening bc there isn't enough money to pay for everything that is needed. So some of the money that needs to go to improved facilities and physicians is used elsewhere to meet other needs deemed to be higher priorities. It's supply restriction bc demand is uncontrollable. Wait times are another type.
And my insurance would pay for my medical treatments at a non-local hospital if no local hospital was available. I know this bc we had to have stuff done at Mayo when no one here was able to do certain tests my DS1 needed. I'm with SBP in that I don't think Canada's hospitals are super shitty, but that we don't want your problems any more than we want our own.
I agree with you to a certain extent, although the fact that the government is willing to pay for the treatment where available says its not rationing as much as its experiencing a temporary shortage of facilities, very specialized ones. iIF the govt had said "too bad, so sad" well yeah, that's rationing.
I agree the GP wait times are an issue but that's wayyyy more complicated than saying its "rationing". We need more med students graduating.
But its not like we don't have our own doctor shortages in the US. I just posted on MM yesterday because I found out my PCP is leaving her practice. Basically I can a) follow the doctor to her new practice, which isn't that feasible because its 45 minutes away and her new hospital affiliation is even farther away or b) find a new doctor. I called three practices in my home city yesterday, none of which are accepting new patients. So now I need to spend lots of time calling around to find an acceptable doctor who is taking new patients - and I live in a medium - small sized city.
The doctor shortage and bed shortage is a form of rationing. It's happening bc there isn't enough money to pay for everything that is needed. So some of the money that needs to go to improved facilities and physicians is used elsewhere to meet other needs deemed to be higher priorities. It's supply restriction bc demand is uncontrollable. Wait times are another type.
And my insurance would pay for my medical treatments at a non-local hospital if no local hospital was available. I know this bc we had to have stuff done at Mayo when no one here was able to do certain tests my DS1 needed. I'm with SBP in that I don't think Canada's hospitals are super shitty, but that we don't want your problems any more than we want our own.
I would personally much rather have Canada's health care problems than those in the U.S., and right now I have phenomenal health insurance through my job. I just know how easy it is to lose that and be unable to be insured. That said, other countries such as Denmark have a single-payer system without the wait times you occasionally hear about in Canada, so there's no reason we would have to go with the Canadian UHC system anyway.
ETA - this is an interesting visual from the WSJ link:
Rationing is a complicated thing too. It's not an obvious concept bc it's not things that are seen. It's easy to see a gargantuan medical bill estimate no one can afford and think "welp thats rationing for you". And it is. But seeing the lack of equipment, or space, or staff is a lot more complicated. The Canadian govt can't tell you "too bad, so sad". It would be illegal. So it has to adopt a more opaque form of rationing to keep costs from spiraling out of control like they are here. Sending people to the US isn't done in every circumstance or even most circumstances. Who knows how many babies were borderline NICU-worthy but didnt get in bc doctors knew it wasn't a life or death situation and other babies in the hospital had a clear priority. Who knows how many people fall through the cracks waiting for transport or just waiting where they are. Your govt restricted the number of available medical school admissions on purpose to reduce the number of doctors. And no matter what it cost to outsource treatments here I'm sure it's still less than expanding NICUs, buying expensive equipment, paying more staff, and the rise in medical bills in Canada. If our supply of care wasn't driving distance from Canada more people would be waited out of care and/or your costs would be much greater.
Love trains et al - I agree some fields are undersupplied in some areas. But it's not nearly as bad as Canada's situation. I think both countries have similar problems. Canada has uninsured people. The US has waits. It's just the proportions of each problem are very different due to the different systems.
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.
For an anecdote, this was me after I had a pulmonary embolism at age 23: I was told that I would not be able to buy individual insurance, ever, no matter what I was willing to pay. So it's not just the working poor; if I hadn't gotten a job with group health insurance I wouldn't be insured. That is a pretty frightening fact to face at 23 when you've recently been hospitalized for a life-threatening condition. (I wasn't married at the time so didn't have an option of coverage through a spouse.)
Likewise, my husband would not have quit working for his previous employer and started his own company (turning him into a job creator!) a couple of years ago if he had not been covered by my company's group plan.
As another anecdote, absent some of the changes that went into place with ACA, could someone tell me precisely how my type 1 diabetic, independent contractor fiance would get healthcare if I'm hit by a bus?
Oh that's right, he wouldn't.
When are we actually going to shift the debate to the cost of healthcare as opposed to the cost of health insurance?
When are we actually going to shift the debate to the cost of healthcare as opposed to the cost of health insurance?
Some ways that the ACA addresses reigning in the cost of healthcare:
Value-Based Purchasing - linking provider payments to performance. Accountable Care Organizations - similar to above, linking payment to outcomes. Payment Bundling/Coordination of Care - rewards providers for coordinating care and reduces unnecessary tests or duplication. The HITECH Act - improving and standardizing health information technology.