PDA

View Full Version : Canadians: health, dental, disability insurance



Blugal
Mar. 17, 2012, 10:38 AM
I'd love to hear your philosophy and experiences with health, dental, and disability insurance. I have been looking into it for a while now. It is so hard to compare quotes since they all offer different things.

I don't have any through work, although if you have experience convincing your work to offer it, please elaborate!

Currently I pay $68/month for Medical Services Plan. It does not provide me with anything extra so far as I can tell, it is just a "you earn enough income to pay a bit towards our health care costs" every month. Given that I rarely use our health system, I feel a bit ripped off!

LittleblackMorgan
Mar. 17, 2012, 10:41 AM
Really? A bit ripped off? Our health insurance (dh and I and incoming baby) costs $1200 out of pocket. Wanna trade?

Blugal
Mar. 17, 2012, 10:45 AM
I have no idea what you pay in taxes, but I'm sure we make up for it in that way.

LittleblackMorgan
Mar. 17, 2012, 10:51 AM
30% of 115k

Blugal
Mar. 17, 2012, 11:02 AM
Interesting - is that straight 30% on the whole amount? Here is a quick breakdown (I am not an accountant, don't quote me!) of ours:

Federal tax:
-15% on the first $42,707 of taxable income, +
-22% on the next $42,707 of taxable income +
-26% on the next $46,992 of taxable income +
-29% of taxable income over $132,406.

Provincial tax (varies from province to province), for BC:
-5.06% on the first $37,013 of taxable income, +
-7.7% on the next $37,015, +
-10.5% on the next $10,965, +
-12.29% on the next $18,212, +
-14.7% on the amount over $103,205


We also have provincial sales taxes. Here in BC, you pay an additional 12% on almost everything you buy (goods & services).

Tapperjockey
Mar. 17, 2012, 11:21 AM
Interesting - is that straight 30% on the whole amount? Here is a quick breakdown (I am not an accountant, don't quote me!) of ours:

Federal tax:
-15% on the first $42,707 of taxable income, +
-22% on the next $42,707 of taxable income +
-26% on the next $46,992 of taxable income +
-29% of taxable income over $132,406.

Provincial tax (varies from province to province), for BC:
-5.06% on the first $37,013 of taxable income, +
-7.7% on the next $37,015, +
-10.5% on the next $10,965, +
-12.29% on the next $18,212, +
-14.7% on the amount over $103,205


We also have provincial sales taxes. Here in BC, you pay an additional 12% on almost everything you buy (goods & services).


Overall, I think that looks like you guys pay more on average. In CA, our sales tax is around 10% and it's the highest in the nation i hear. (I have not compared.. it will depress me more. I moved here from a state with 5.5% sales tax lol). Some states have no income tax for the state, but most do.

Do you guys pay property tax?

Blugal
Mar. 17, 2012, 11:26 AM
Yes, we pay property tax. Also unless you are a first-time home buyer in BC, you pay a transfer tax when you buy property.

Probably similar in the States, there are also capital gains taxes on investments.

FalseImpression
Mar. 17, 2012, 11:31 AM
I am in Ontario and my income is low enough that I really hardly pay anything on an annual basis for my Provincial Health Care. The most I paid years ago was $300/year!
I do not have any other insurance (ie physio, meds, eye, dental), but I do not hesitate to go visit a doctor, hospital. They order tests that I don't pay for.
Again, my income is low enough (retired) that my taxes probably do not even cover what I get!
I only buy out of country/province insurance (through CAA) at a cost of $120/yr when I intend to travel out of Ontario and abroad.

I still feel we get a great deal and I would not change it.

In Ontario, we pay 13% on everything (8% provincial sales tax + 5% federal tax). And of course, we pay property taxes which vary of course.

NotGrandPrixYet
Mar. 17, 2012, 11:41 AM
How long is the waiting time in Canada to:

See a doctor for a routine check up?

See a doctor for something non-life threatening? (like chicken pox or something)?

Schedule surgery for something non-life threatening (like a hip replacement, etc)?

Schedule cancer diagnostics and treatment for a 70 year old person (or older)?

It has been said by others here in the U.S. that people come here from Canada all of the time because they cannot get the treatments that they want or need in a timely fashion up there. It would be good to know if the things that I have heard are true.

Blugal
Mar. 17, 2012, 11:47 AM
It depends, on availability, waiting lists, what area of the province/country, whether you have a family doctor, etc.

My answers, in my own experience, in bold:

How long is the waiting time in Canada to:

See a doctor for a routine check up? Call & make an appointment, or just walk in.

See a doctor for something non-life threatening? (like chicken pox or something)? Just walk in to your doctor's office or to the emergency room.

Schedule surgery for something non-life threatening (like a hip replacement, etc)? It really, really depends. Both my parents have had MRIs scheduled (one for a bad back, one for a possibly torn rotator cuff) and they have taken months.

Schedule cancer diagnostics and treatment for a 70 year old person (or older)? I have barely any idea. People I barely know seem to be okay with the times for this. The unhappy experiences I have heard were missed or erroneous diagnosis.

It has been said by others here in the U.S. that people come here from Canada all of the time because they cannot get the treatments that they want or need in a timely fashion up there. It would be good to know if the things that I have heard are true. I don't personally know anybody who has gone to the US, or elsewhere, for treatment.

handfish
Mar. 17, 2012, 11:50 AM
As for feeling ripped off, it's insurance-- young and healthy people subsidize old and sick peoples' care so that when it's your turn to be old and sick, you'll be cared for. I'm just glad that everyone pays in, because it keeps the costs reasonable. If, by some miracle you never get sick or injured (or old!), you're only out $68/ month.

My insurance in the US costs me about the same as in Alberta's old premium, but that's in addition to all of my co-pays and exemptions. It's crazy.

Ravencrest_Camp
Mar. 17, 2012, 02:09 PM
Given that I rarely use our health system, I feel a bit ripped off!


I have not heard of one instance where a Canadian went bankrupt because of medical bills.

I have not known one Canadian who was in dire financial straights because he or she paid too much in taxes. Canada has a progressive tax system, those who earn more and can afford it, pay more. I once had a Chartered Accountant tell me "be happy you are paying a lot of tax, it means you earned a lot"

I have however heard of people in the US losing their houses, and much more because of medical bills.

And although you may feel ripped off right now, at some point in your life you are going to need medical treatment. Personally I would rather not have to worry about the financial hardship of a hospital stay.

Ravencrest_Camp
Mar. 17, 2012, 02:19 PM
How long is the waiting time in Canada to:

See a doctor for a routine check up?

See a doctor for something non-life threatening? (like chicken pox or something)?

Schedule surgery for something non-life threatening (like a hip replacement, etc)?

Schedule cancer diagnostics and treatment for a 70 year old person (or older)?

It has been said by others here in the U.S. that people come here from Canada all of the time because they cannot get the treatments that they want or need in a timely fashion up there. It would be good to know if the things that I have heard are true.

There is an important distinction between need and want.

It has been my personal experience that when a test or procedure is medically needed or urgent, it is done right away. When it is not medically urgent, there may be a wait.

As an example, when my son was young he started having bouts of incontinence. We got him in to see a doctor and he had an MRI done the next day, because of the danger of a possible tumour. On the other hand when my wife was experiencing back pain, it took her several months to get an MRI.

It's really a matter of balancing what you really need and what is nice to have.

As for the 70 year old plus person needing cancer treatment. We would probably have one of our death panels put him on an ice flow and push him out to see. :D:lol: Sorry couldn't resist.

mht
Mar. 17, 2012, 02:51 PM
Two recent examples of cancer diagnosis/treatment.

S.I.L-shadow found on lung xray for unrelated condition. Saw specialist within one week, had biopsy next week, had surgery the next week. In hospital for five days, now home and doing well.

Husband of former employee-thought to have prostate problems, tested, not the cause, sent to specialist, found to be bladder cancer, had surgery within two weeks of original diagnosis, seeing specialist this coming week to determine course of action. All of this six weeks, total. It all depends on what part of the country you live in.

FalseImpression
Mar. 17, 2012, 07:54 PM
I agree that it's all a matter of urgency. My husband was not in a rush to get his hip replaced, however, he had it done within 6 weeks of he and the surgeon deciding that was the way to proceed.

In 99, I had a bc diagnosis. Surgeon called with biopsy results on June 9, had surgery on June 18. Chemo, etc. No charge.

I broke my ankle in Dec. 08. Went to ER, signed in at 1 10... was on the operating table at 3 pm. Several visits, cast, etc. NO charge. By the way, that was the same year I did pay $300 to the government because my income was higher. I think I was still ahead.

To see my doctor? An emergency not requiring stitches,xrays... same day. His last appts are always left for this purpose.
Something less urgent, within a few days.
An annual physical? 6 weeks.
Other tests (ie blood work, xrays), just walk in at the lab, present your health card. That's it.

LauraKY
Mar. 17, 2012, 08:31 PM
Yet many in the U.S. are against single payer health care. Afraid of change? I just don't know.

Coanteen
Mar. 17, 2012, 08:32 PM
There might be a longer wait for routine, non-urgent appointments requiring more time, like annual physicals. For something that comes up and just needs a walk-in non-ER appointment, in many places you can be seen same day or next day; of course if you live in a little town with only 1 or 2 overrun clinics, that might differ.

The US certainly does better than Canada on wait times for specialist appointments, some diagnostic procedures (getting an XR takes no time in Canada...a non-emergent MRI is another story), and elective surgery. Canada is/was especially bad at elective ortho surgery like knee/hip replacement, bad enough that a court case finally forced the government to either guarantee reasonable wait times or allow for-profit ortho surgical centers (these exist now in several provinces, and do only the procedures for which the wait times in the public system are deemed too long).

Coanteen
Mar. 17, 2012, 08:36 PM
Yet many in the U.S. are against single payer health care. Afraid of change? I just don't know.

Single payer works best with a gate-keeper system, and the US isn't used to that either. In Canada and the UK you see a specialist after being referred by a GP; I'm not 100% sure about the UK, but in Canada you can't see a specialist on your own as an outpatient unless either a GP or an ER doc refers you. Their billing has to include the ID number of the referring physician, otherwise they won't get paid.

(Insured) patients in the US can see many specialists on their own as they want to, so (the more expensive) specialists end up seeing stuff that any (less expensive) GP could handle. Like grade 1 or 2 acne, for example, going to a derm.

CruzN
Mar. 17, 2012, 08:46 PM
My recent experience with the Canadian healthcare system was quite positive.

Monday aft: I stepped on a (rusty) nail, just after walking through the muddy barn yard. That night I went to Emergency, took about a half an hour to see a doctor who gave me a tetanus shot, and antibiots.

Tuesday a.m.: Called my family doctor, told me to come right in, walked right into his office when I got there. He sent me back to the hospital for IV antibiotics. Went to the hospital, waited about half an hour for the IV antibiots.

Wednseday a.m.: Went back to the hospital for my second round of IV antibiotics. Waited maybe 45 minutes. Nurse felt that my foot was worse, so had the doctor look at it, who recommended I see the ortho specialist at another hospital. Went to that hospital, waited about an hour to see ortho guy, who immediately decided I needed surgery to clean the infection out of my foot. About 6 hours later was in surgery. Had to stay in the hospital until Friday afternoon, due to intensive IV antibiotics treatments...

So, had a 3 day stay in hospital, had surgery, lots and lots of antibiotics- total cost? ZERO DOLLARS. You wont catch me complaining about our healthcare anytime soon.

MoonoverMississippi
Mar. 17, 2012, 08:49 PM
Single payer works best with a gate-keeper system, and the US isn't used to that either. In Canada and the UK you see a specialist after being referred by a GP; I'm not 100% sure about the UK, but in Canada you can't see a specialist on your own as an outpatient unless either a GP or an ER doc refers you. Their billing has to include the ID number of the referring physician, otherwise they won't get paid.

(Insured) patients in the US can see many specialists on their own as they want to, so (the more expensive) specialists end up seeing stuff that any (less expensive) GP could handle. Like grade 1 or 2 acne, for example, going to a derm.

I wish! Every employer sponsored health insurance we have had required a visit to your GP who would refer you to specialists. I never had a problem getting a referral to a specialist I wanted to see, but we've always had to make the trip to the GP for referal first, or insurance would deny the claim. This includes 3 different insurance companies, currently BC/BS. The trade off is no deductable and low co-pays.

FalseImpression
Mar. 17, 2012, 09:16 PM
Canada is/was especially bad at elective ortho surgery like knee/hip replacement,

In my husband's case... 6 weeks was really good. It was not an emergency at all. However, to be fair, we had requested to see a specialist in another city (40 min. south of us) and the wait times to see him and to get surgery were shorter than in town.

Saw him on August 10 for a knee problem, had arthroscopic surgery on the 12th!! At a later follow up visit in late October, my husband mentioned his hip. Surgeon had xrays taken the same day and agreed that replacement was the way to go. His secretary called a few days later and offered us Dec. 4!!

That was a lot sooner than we had expected!

And again, the only expense while in hospital was parking!!

lawndart
Mar. 17, 2012, 09:22 PM
I know that is not the question posed by the OP, but in comparison, my monthly health ins bill is $300.13. No prescription, no dental, no eye care. Just me on the policy. Since I'm self-employed I get to pay all of it.

I had a ER Visit about a month ago (run over by a horse) when I hit my head quite hard on the concrete.

4 hours in ER, One MRI, One X-ray of shoulder and Jaw, saw 2 nurses, one PA and one Dr. 3 staples in my head later, I was discharged after a painkiller was given IM, and given a prescription for 'more if needed'. Had a mild concussion, cut in head, and bruises and contusions.

Just got the bill today: Total of $5208. Amount due by me? $75. And if I pay promptly, I get a discount. :winkgrin: My insurance is Geisinger Health Plan. I am quite satisfied with this.

I have no problem getting appointments at my local Dr's office either, tho I usually get a PA instead of a Dr. My last Pap was abnormal, they had an appt with a GYN the next day.

Now, I've not had a serious illness in 23 years. Maybe if I did, My outlook on US healthcare would be totally different. I can only speak of what I personally know.

I'm not knocking Canadian Health Care at ALL, just saying not everyone in the US is dissatisfied with our health care.

FalseImpression
Mar. 17, 2012, 09:30 PM
oh my... you pay $300 x 12 = $3600/yr and you are happy? so, you have been paying this for how many years? and you are happy that you only had to pay $75?
I pay nowhere near that (as I said I paid $300/yr about 3 years ago), nothing since and never left a hospital with a bill, even $75! Isn't it nice your insurance could give you a break!! they don't give anything back when you have no claim, do they?
wow.
Thank you Canada!!

texan
Mar. 17, 2012, 09:37 PM
I know that is not the question posed by the OP, but in comparison, my monthly health ins bill is $300.13. No prescription, no dental, no eye care. Just me on the policy. Since I'm self-employed I get to pay all of it.

I had a ER Visit about a month ago (run over by a horse) when I hit my head quite hard on the concrete.

4 hours in ER, One MRI, One X-ray of shoulder and Jaw, saw 2 nurses, one PA and one Dr. 3 staples in my head later, I was discharged after a painkiller was given IM, and given a prescription for 'more if needed'. Had a mild concussion, cut in head, and bruises and contusions.

Just got the bill today: Total of $5208. Amount due by me? $75. And if I pay promptly, I get a discount. :winkgrin: My insurance is Geisinger Health Plan. I am quite satisfied with this.

I have no problem getting appointments at my local Dr's office either, tho I usually get a PA instead of a Dr. My last Pap was abnormal, they had an appt with a GYN the next day.

Now, I've not had a serious illness in 23 years. Maybe if I did, My outlook on US healthcare would be totally different. I can only speak of what I personally know.

I'm not knocking Canadian Health Care at ALL, just saying not everyone in the US is dissatisfied with our health care.

All of the above in Canada would cost you nothing. The rich, middle class and poor. The point is, its great you are able to pay for health insurance, but not everyone is as fortunate as you.
Only the people able to afford the insurance are not dissatisfied, how about everyone else.

lawndart
Mar. 17, 2012, 09:39 PM
oh my... you pay $300 x 12 = $3600/yr and you are happy? so, you have been paying this for how many years? and you are happy that you only had to pay $75?
I pay nowhere near that (as I said I paid $300/yr about 3 years ago), nothing since and never left a hospital with a bill, even $75! Isn't it nice your insurance could give you a break!! they don't give anything back when you have no claim, do they?
wow.
Thank you Canada!!

False Impression, I'm glad you are happy with your health plan in Canada.

I'd like to note that my personal taxes are no where near as high as yours. Probably because as a self-employed business I can deduct that $3600 as a business expense.

So you technically pay just as much as I do.

Nothing in life is free, unless you are lucky enough to marry lots of money. and that probably has its downside too. I don't have a problem paying my way in life, and helping to support those who cannot. What bothers me is the those who cheat the system. I assume you don't have those in Canada? :winkgrin:

Coanteen
Mar. 17, 2012, 09:42 PM
oh my... you pay $300 x 12 = $3600/yr and you are happy? so, you have been paying this for how many years? and you are happy that you only had to pay $75?
I pay nowhere near that (as I said I paid $300/yr about 3 years ago), nothing since and never left a hospital with a bill, even $75! Isn't it nice your insurance could give you a break!! they don't give anything back when you have no claim, do they?
wow.
Thank you Canada!!

She also pays about 3% state income tax. You pay about 5% provincial on your first $39k, and almost double on anything past that. Hell, I just got posted to NB - I'll be paying starting at 9% for the first $38k and climbing thereafter.
And she can write her mortgage interest off her taxes if she has a mortgage.

We Canucks pay for our health care through our taxes, USians pay less taxes but pay for health care more directly. Their way does cause problems for the individuals rather than the system, but our health care certainly isn't free.

Chall
Mar. 17, 2012, 09:47 PM
Curious, how many non-doctors do you see when you go to the doctor?

In the last two years everything health care related seems crazy to me. I saw 5 receptionists before I saw a doctor for 5 minutes; there were 4 at the entrance to the building (to make sure you have insurance), three at the window of the 40 person waiting room, one girl who showed be to a room, one physicians assistant, then the doctor.
For the tick that I got on my neck? My doctor was out (thurs afternoons), so had to go their emergent care ( no they don't have covering physicians). Had one guy show me to the room, a Pa examine and pull it and a doctor so young I had to ask her age (28, but looked 21). For the ONE pill antibiotic she wanted to call it into the pharmacy - whose address I wasn't sure of. Please, am I going to sell it?
Whole cost was $500.
I grew up with one physician who knew me, had a covering physician who you saw during his vacations and both belonged to the neighborhood hospital.
I really dislike the new health care.

Karosel
Mar. 17, 2012, 09:49 PM
My experiences and my family members with the Canadian health care system have all been positive.

My dad has had colon cancer and kidney stone problems. My mom had a some weird hard swelling on her neck, and had an MRI right away once she went to the ER.

If it's an emergency or urgent you will get treatment right away. However, I must say it is frustrating when people 'misuse' the system (well in my opinion). For example, the post doc in my lab takes her kids and herself to the doctor for every little minor thing. ie. 7 year old kid had a 'tummy ache' one morning but was well enough (no fever, nausea, head ache diarreah. nothing) to come in to the office with her for the day and play around on the computer until his dr. appointment in the afternoon. :rolleyes: The Dr. told her nothing was wrong with the kid. There is a hotline here to call to talk to a nurse to help determine which healthcare avenue (ER, family dr etc) to take.

Chall
Mar. 17, 2012, 09:50 PM
Oh, I pay 600 a month so 7200 a year.

mercedespony
Mar. 17, 2012, 09:56 PM
Curious, how many non-doctors do you see when you go to the doctor??.

?? I only see my doctor... I mean, I have to make an appointment with the receptionist, and the nurse meets me for 5 minutes to discuss what I'm there about and does a dreaded weigh-in, my chart goes on the door and in 10 minutes my doctor walks in. She's been my family doctor for the last 16 years, she knows everything about me.\\

I pay nothing out of pocket (well, taxes, of course).

FalseImpression
Mar. 17, 2012, 10:18 PM
ha, but I don't make much so don't pay much in taxes any way. I still would rather pay through my taxes so everyone can benefit from our health care, than pay through the nose to a private for profit company which then decides where I can go for care and how much care I can get.

I hate it when I read threads here where people hesitate/can't go to see a doctor for something that, really, should be seen because they don't have insurance!

At least, if I had a serious illness and lost my job, I would not have to worry about having a pre-existing condition and not getting treatment! I can also claim any medical expense (dental/eyecare, physio and meds not covered by the government program) from my taxes.
To me, peace of mind is worth a lot.

lawndart
Mar. 17, 2012, 10:23 PM
ha,

At least, if I had a serious illness and lost my job, I would not have to worry about having a pre-existing condition and not getting treatment! To me, peace of mind is worth a lot.

This right here is what makes the Canadian system superior to the US system.

Blugal
Mar. 17, 2012, 10:58 PM
Thanks for weighing in everyone - some interesting responses. I know it's off-topic day so I expected nothing less than this thread to go in unexpected directions!

Like many or all of the Canadians chiming in here, I am perfectly happy with the majority of what our health care system does. I am not happy about having to figure out additional insurance for things like dental, which in my opinion, should have a basic coverage in the health care system. But anyway...

I should re-state my feelings about my $68/month. I wish they would just roll it into the taxes I am paying, even if it made those taxes higher by $68 or 70/month. I hate getting the stupid $68/month reminder which seems to be about... nothing. They could eliminate this ridiculous "we print your invoice, mail it to you, you get it and have another bill to pay, if you don't we have to remind you or go after you" - I think there are better ways of going about this.

FalseImpression
Mar. 17, 2012, 11:50 PM
In Ontario, you do not get an invoice. When you do your tax return, then according to your income, an amount is added to your taxes somewhere in the calculation.
I remember looking up a while ago because of one of these threads, how much a top earner would have to pay for health "insurance". I seem to recall a $900/yr maximum. The numbers may have changed, but it was an annual amount, not a monthly one.

Blugal
Mar. 18, 2012, 12:55 AM
Interesting. I am not a top earner, and mine works out to $816/yr. But who knows what the actual "health care amount" is?

I do think that is a problem that we as well as Americans are going to continue facing - how will we afford all the latest treatments for every ailment, as more and more (expensive) treatments become available, and more and more people are living longer & using more health care?

bumknees
Mar. 18, 2012, 05:53 AM
I sometime get involved in these topics sometimes dont depends on attitude.. I like this attitude...

I was going to ask our friends to the north what their actual cost really is in their tax rate, someone listed it in the beginning and it is mind boggeling start at this then on the next $ it is that % so on so forth.. Id need and accountant to figure it out.. Here in the US it is pretty straight foward fed is X % state is Y % if you have city and county Q % c% many county and city dont have %...

So Im going to ask if someone in Canada( and I realize that diffrent provances have diffrent tax rates and each seem to run as their own independant country until something is needed or wanted.) pre tax earning earns 100k$ canadian how much of that is taxed/removed anually for their health?
I ask because how many Canadians have come her and said " It doesnt or did not cost me anything.' Or " It was free." and that is really a misnomer isnt it?

Realizing that each area is diffrent and probably each larger populated area like here is diffrent Ie someone here in the states living in a city like Los angles may pay a higher preimum than someone in east podunk would even though they may have identical coverage from the same company.
I dont think that other than the provances in Canada there is anything that I can compare to our state system here in the US..

Ours may not be the best set up but it is what we got. And yes I think someone else hit it on the head when they said we dont operate on the
gate keeper system.
Depending on what type of insurance one has some if not most of us can call up a dr any type of Dr and make an apt. I enjoied that availabilty to do that when I had it. If I felt like I may have broken a bone ( IE my foot like I did mm 3 weekends ago) I should with out having to go through my gp first) call up an ortho and say Hey I did a bone head move and now my foot is the size of a watrmellon. That right there is grounds to see an ortho with out seeing my gp first... BUT because I am on govt. run isurance I needed a referal which took time to get into my gp then time for the referal to get to the ortho then time for the ortho's schedule to clear a spot so almost a week AFTER the fracture occured I was able to see a ortho. Instead of the monday after my bone head manaver me calling calling around to find one that took my insurance and getting in just as sooon as possible... had to wait .. that is what the govt. does hurry up and ewait.. oh yeah wait for us to fill out forms while you ait and some other bone head accidently hits the foot that you in your bon head move broke and my nurse tells you to hush as ou are making the others upset by your yelling at bone head as your hands wrap around neck of bone head .. you get the drift...:cry:
Yeah see me caling ortho much better....

the differance betwen the two is one is a PPO the other is either called Managed care or a HMO or Health Maintance Org. the PPO is in a nut shell one with a deductable in which you can call a dr which accepts your insurance but you dont need referals. And at least when I had one you pretty much called the shots when it cam to what drs you saw.
A managed care and /or HMO they call the shots and can turn down things like oh gee MRI, CT scans etc IF they feel as though you may have had to many that year. They may also question the drugs your dr scripted you and ask, demand they try something else even if you have alred tried that somethign else once upon a time and it doesnt work or worse you are allergic to it.
I have had many battles with my ''managed care'' they have actually told me to go onto a drug that I am ''will land in hospita faster than I know what hit mel'' allergic to because the one that I am/was on is to expensive. I spent mmm 4 or 5 hrs (several days worth of 4 or 5 hr)on the phone TG it was a toll free number ... I had to get on the phone drs I had not talked to in years after I tracked them down of course to get them to remember me, get them to remember the partcular drug and what it did to my particular body.. It was not a fun time for me as you can imagine... to this day I do not know if those particular Drs actually remembeed me and what happens wit hthe drug or just said the words to help out someone kwim...

If I could tomorrow If given a choice... I would drop the managed care option and go for a PPO... but for what I can afford, what I have medically( way to many preexiting conditions, ) and trying to coodinate my dr's with insurance ie do my drs accept this or that insurance... better to keep the dragon I have than to tame a new one kwim... hate it every second...

carolprudm
Mar. 18, 2012, 08:39 AM
Yet many in the U.S. are against single payer health care. Afraid of change? I just don't know.
Because I don't want the same people who have brought the government to a stage of terminal constipation to determine my health care.

Tapperjockey
Mar. 18, 2012, 09:04 AM
Because I don't want the same people who have brought the government to a stage of terminal constipation to determine my health care.

Yup!!!!


I love Donald Trump's opinion...

“Let me get this straight. We're going to be “gifted” with a health care plan we are forced to purchase and fined if we don't, which purportedly covers at least 10 million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn't understand it, passed by a Congress that didn't read it, but exempted themselves from it, and signed by a Dumbo president who smokes, with funding administered by a treasury chief who didn't pay his taxes, for which we'll be taxed for four years before any benefits take effect, by a government which has already bankrupted Social Security and Medicare, all to be overseen by a Surgeon General who is obese, and financed by a country that's broke.
What the hell could possibly go wrong?”

handfish
Mar. 18, 2012, 10:15 AM
I suppose a prerequisite for a working single-payer system is a government that has a grip on reality, which is most definitely not the case in the US!

OK, sorry Americans.

Coanteen
Mar. 18, 2012, 10:29 AM
So Im going to ask if someone in Canada( and I realize that diffrent provances have diffrent tax rates and each seem to run as their own independant country until something is needed or wanted.) pre tax earning earns 100k$ canadian how much of that is taxed/removed anually for their health?
I ask because how many Canadians have come her and said " It doesnt or did not cost me anything.' Or " It was free." and that is really a misnomer isnt it?


That would be hard because the health care premium of course doesn't cover all of health care. What you could do is see how much someone in Canada who earn $100k pays in income taxes per province; there are online calculators that do these calculations because the marginal rates are hard to deal with.

So for $100k, Alberta and BC are your best provinces (as income goes up Alberta wins, because it's the one province with a flat rate of 10%, rather than a marginal rate).
For ex, for $100k, income tax due without any RRSP contributions, child tax credits, etc etc - just income tax, which the things I mentioned will change a little bit.
BC: 25,060
Ontario: 27,051
NB: 28,252
Manitoba: 30,833

And then stuff like CPP/EI premiums change it too (Canada Pension Plan). With CPP/EI but no allowable deductions a calculator gives me 30,383 in total "taxes" for NB, for BC 27,466.

Blugal
Mar. 18, 2012, 11:04 AM
Coanteen, I didn't actually do the math, but those figures seem high. I am remembering filling out my taxes and having the "basic personal exemption" on roughly $9,000 - I think this means the first $9,000 isn't taxed. My guess, people earning in that range are below poverty level and aren't getting taxed on it.

Coanteen
Mar. 18, 2012, 11:11 AM
Coanteen, I didn't actually do the math, but those figures seem high. I am remembering filling out my taxes and having the "basic personal exemption" on roughly $9,000 - I think this means the first $9,000 isn't taxed. My guess, people earning in that range are below poverty level and aren't getting taxed on it.

They come from 3 separate income tax calculators, a pretty involved one at http://www.taxtips.ca/calculators/taxcalculator.htm
and a simple one at
http://www.tax-services.ca/canadian-tax-calculator/income-tax-calculator-canada.html
and an overview one at
http://lsminsurance.ca/calculators/canada/income-tax

I would assume the personal exemption would be included in the calculation formula, but as I said, no allowable deductions like RRSP etc are included.

Edit: looking at my T4 from 2011, I'm paying 29% purely in income tax. That's just dividing the "income tax deducted" by "employment income", ignoring the "employee's CPP contributions" and EI boxes that would drive it up higher.

pj
Mar. 18, 2012, 11:13 AM
As for the 70 year old plus person needing cancer treatment. We would probably have one of our death panels put him on an ice flow and push him out to see. :D:lol: Sorry couldn't resist.

:lol::lol: I can see looking out over the water and seeing lots of ice flows, each with a little old person sitting on it. Family members on shore throwing kisses and waving.....WAIT. I'm seventy one...that's not funny. :)

bumknees
Mar. 18, 2012, 11:15 AM
you pay aprox 30+K a yr in taxes of which a portion is for your health care. assuming of course the 100k in income.

your health care doesnt over everything correct? Im not being snotty or anything Im trying to learn.. What happens if you were to have something that it doesnt cover? Or only patialy cover something?Do you carry something like supplemential insurance or private on top of the govt. isurance? Or do you trek to the US?

See here insurance after deductable etc are met it pretty much covers everything. Yeah there are things that even govt. insurance will not cover due to laws. ie it is illegal for military dependants to have an abortions..
And prior to obamacare there was a preexisting condition clauses where if you had one that would be excluded for a period of like 6mths then it would be covered.

Blugal
Mar. 18, 2012, 11:22 AM
you pay aprox 30+K a yr in taxes of which a portion is for your health care. assuming of course the 100k in income.

That's about it! Plus, your provincial sales tax (12% in BC), plus your $68/month for Medical Services Plan, which I was complaining about in my OP.


your health care doesnt over everything correct? Im not being snotty or anything Im trying to learn.. What happens if you were to have something that it doesnt cover? Or only patialy cover something?Do you carry something like supplemential insurance or private on top of the govt. isurance? Or do you trek to the US?

Well it covers most stuff. It does not cover dental (hence, my OP), it does not cover massage therapy, certain alternative medicines and therapies, or vision checks/eyeglasses. So "health care" is a term that is definitely limited.

You pay for your own prescriptions to a certain point, but I think the amount you pay is already subsidized. I can only deduct legitimate medical expenses from my income when they exceed $750 in a year.

Coanteen
Mar. 18, 2012, 11:29 AM
you pay aprox 30+K a yr in taxes of which a portion is for your health care. assuming of course the 100k in income.

your health care doesnt over everything correct? Im not being snotty or anything Im trying to learn.. What happens if you were to have something that it doesnt cover? Or only patialy cover something?Do you carry something like supplemential insurance or private on top of the govt. isurance? Or do you trek to the US?

See here insurance after deductable etc are met it pretty much covers everything. Yeah there are things that even govt. insurance will not cover due to laws. ie it is illegal for military dependants to have an abortions..
And prior to obamacare there was a preexisting condition clauses where if you had one that would be excluded for a period of like 6mths then it would be covered.

It covers pretty much everything except outpatient meds (so all meds you get while hospitalized are covered, but your routine prescription is not - you have to have separate insurance for that, often through work; there are programs to cover people on social assistance and some catastrophic conditions where the cost of meds would bankrupt a person), vision (glasses and stuff, not optho emergencies which would of course be covered) and dental, and then stuff like chiro, PT etc. Elective cosmetic surgery also isn't covered, and some stuff like IVF (which I think is covered if you have both Fallopian tubes blocked, but not otherwise? That was a few years ago, if it changed I don't know).

No pre-existing anything: you don't sign up for insurance like you do in the US and "disclose" anything, you're automatically covered, as you are, as a resident of whatever province. There is a waiting period for new immigrants, I believe? Not sure, but any Canadian is covered by their provincial plan without any pre-existing disclosure things like in the US.

Tapperjockey
Mar. 18, 2012, 11:31 AM
I suppose a prerequisite for a working single-payer system is a government that has a grip on reality, which is most definitely not the case in the US!

OK, sorry Americans.

Yes.. We are all sorry about that too *sigh* lol

handfish
Mar. 18, 2012, 11:40 AM
Wow, so make 100k, pay $30k? I never knew, never having broken out of the lower tax brackets :D

So, back on original topic, I'd say if you were healthy and didn't have many pills to buy, you don't really need supplemental.

As a rider, though, you'd need to save up a couple of thousand, just in case you need an ambulance. Basic dental check-ups are what? A hundred or two? Do it once or twice a year and hope you don't need anything more than cleanings.

My supplemental insurance (through my workplace) was kind of crap for vision care, so if you can cough up the annual amount for an eye exam, don't bother. If you need glasses/contacts, check to make sure it covers frames and lenses, and any fancy lens extras you like. I NEED high index anti-glare, or else, Coke bottles.

rodawn
Mar. 18, 2012, 11:49 AM
Blugal, I live in Alberta. We pay nothing per month. All Albertans pay nothing. As far as I know, we're about the only province that has that privilege.

Usually federal taxes and provincial taxes are collected so that the hospital structure and staffing are paid. That's the Federal transfers we hear about. However, that is also why every single Canadian gets hospital coverage no matter what their income. And nobody has to decide to sell their house versus getting their medical care.

A Canadian can choose their own medical doctor. In the US, some insurance companies tell their clients what doctors they can or cannot use. In Canada, you can see that doctor as many times a year as you need to. The insurance cannot tell you what constitutes too much use. In Canada, you are not penalized with a higher premium because you ride a horse, or penalized with higher premiums if you've been injured a few too many times, or have gotten sick a few too many times. Or because your daughter has leukemia and needs radiation and a bone marrow transplant.

A homeless guy who is found half frozen to death on the streets by the police can be brought to the ER and receive full treatment until discharge and isn't charged a single penny. The care he receives is just as good as any paying insured citizen, even if it is an extensive hospital stay requiring surgery to remove frost bitten toes and fingers.

A person who is involved in a catastrophic plane crash or car accident and spends 6 months or 6 years in hospital is FULLY covered. Some of the extra rehabilitation is not covered in your basic monthly medical, and that is where the extra optional insurance comes in handy.

Instead of feeling ripped off, consider that Canada's Constitution stipulates that it is the RIGHT of every single man, woman, and child, regardless of social status, to get full healthcare. That means some of us subsidize those who do not or cannot work. By the standards of many in the world, we have it pretty darn good. You might be healthy now, but you will get old eventually and tomorrow's young people will be paying for YOUR increasing health care needs as you age.

For beyond the basic, we use Blue Cross, which covers your ambulance trip or, here in Alberta, your STARS helicopter-ambulance trip, dental, eye exams, some medications.

The whole premise of the Canadian medical system is that no matter how sick a man, woman, or child gets, they canNOT be cut off from insurance, ever, AND you don't have to decide whether to sell your house and all your belongings versus getting medical treatment you need to have.

Even our medications are cheaper as a whole, because they are subsidized by our medical system.

Does it mean our taxes and cost of living are higher? YES. But the trade off is a healthier social public, or rather, a TREATED social public so that they have a good opportunity to get well again, be it treatment for cancer, liver disease, heart disease, whatever. Do some people abuse it? Yes, because they've never lived in a society where they couldn't get medical coverage so they don't seem to realize the value of what we currently have.

I, for one, gladly pay the taxes, because I appreciate Human RIGHTS. And Canada has decent human rights!

I've worked in the American medical system. I currently work in the Canadian medical system. There are pros and cons to both systems and neither system is perfect. I'm living in Canada, and that is because I feel the pros far, far, far, FAR outweigh any cons with the Canadian system.

abrant
Mar. 18, 2012, 12:14 PM
I was going to ask our friends to the north what their actual cost really is in their tax rate, someone listed it in the beginning and it is mind boggeling start at this then on the next $ it is that % so on so forth.. Id need and accountant to figure it out.. Here in the US it is pretty straight foward fed is X % state is Y % if you have city and county Q % c% many county and city dont have %...


No, it's not, our tax brackets work the same way :)

If I had magically leapt from 15% to 25% when I got a 'real job' I would have been pretty disgusted. Now, I pay the higher rates only on what I make over the maximums for the lower rates. Just like the Canadians :)

And for those Canadians who want to appreciate what they have. I pay about $70 a month for an HSA high-deductible health care plan. My employer contributes approx $190 a month. I pay everything that's not considered preventive care up to $2500/year. Of course, the plan is kind enough to let me save money in a health savings account tax-free. Starting in 2013 this will be the only plan my employer (very reputable, international company) will offer. We're joking that there is going to be a baby boom before people lose their PPO. Of course, I can't imagine addding a dependent at this point since it doubles my cost and increases the deductible to $7500/year.

Ravencrest_Camp
Mar. 18, 2012, 12:46 PM
Instead of feeling ripped off, consider that Canada's Constitution stipulates that it is the RIGHT of every single man, woman, and child, regardless of social status, to get full healthcare. That means some of us subsidize those who do not or cannot work. By the standards of many in the world, we have it pretty darn good. You might be healthy now, but you will get old eventually and tomorrow's young people will be paying for YOUR increasing health care needs as you age.



Excellent post rodawn, very good summary of the health care system in Canada.

One thing though, the Constitution does not guarantee the right to health care. The Canada Health Act outlines what under what conditions the provinces have to provide health care in order to receive federal money. The the closest we get to a guarantee, and it is an act of parliament not part of the constitution. As such it can be changed, amended or abolished by another act of parliament.

As for the funding of health care, that is done out of general tax revenue, so some portion of the taxes Canadians pay go towards health care. Trying to figure out how much of the taxes you personally pay go towards health care would be next to impossible.

Each province has a different tax structure. In Ontario there is an Employer's Health Tax paid by employers on the gross amount of their payroll. The first $400K is exempt and then there is a sliding scale up, with the highest rate being 1.95%. Individuals pay an Ontario Health Premium. Even though it is called a premium, it is really just a tax. The only reason it is called a premium is because the government that brought it in campaigned on a promise not to raise taxes. If you earn under $20K you do not pay the premium. From there it is a progressively higher premium as you income goes up, with a maximum of $900/year for those earning over $200 600.00 per year.

Even though these two taxes are for health care, they go into general tax revenue. They also are not the only source of health care funding.

FalseImpression
Mar. 18, 2012, 12:46 PM
Rodawn, thank you.
Very clear explanation.
Here is the chart showing the Health Care Premium added to your income tax in Ontario.
http://www.rev.gov.on.ca/en/tax/healthpremium/rates.html
Most years, I do not pay anything and, as I said, the highest premium is still only $900/yr for an income of $200K+ a year. How many of you pay this on a monthly basis?
No, it does not cover everything, but heck, doctors' visits, tests, hospitalizations, would cost a bundle... no deductible.
Bumknees, in your case with your foot, I would have gone to the ER. That's what I did when I fell and broke my ankle. No need to go see my GP as he would not have been able to do anything about it. I was very lucky that it was a Monday, right after lunch. The ortho dpt has a fracture clinic every Monday morning and the surgeon was still in the hospital. There was OR time and staff available and I was whisked in there in record time. It was great timing on my part and I had not eaten anything since 8 am... I barely had time to sign the papers as the surgeon was right there, ready to wheel me in the OR himself. It was actually quite funny!!
I was sent home later that night. All the repeat visits at the fracture clinic, change of cast, removal of staples, all covered. I still had private insurance then which covered my physio and what was not covered could be claimed on my income tax return the following year.

As I said earlier... paying more taxes in Canada.. well, what kind of price do you put on peace of mind?

Gray Horse H/J
Mar. 18, 2012, 12:55 PM
I wish! Every employer sponsored health insurance we have had required a visit to your GP who would refer you to specialists. I never had a problem getting a referral to a specialist I wanted to see, but we've always had to make the trip to the GP for referal first, or insurance would deny the claim. This includes 3 different insurance companies, currently BC/BS. The trade off is no deductable and low co-pays.

Do you have an HMO? HMOs require referrals for everything beyond your PCP and, if you're a woman, your OB/GYN.

Many PPOs do not require them.

rodawn
Mar. 18, 2012, 01:50 PM
Excellent post rodawn, very good summary of the health care system in Canada.

One thing though, the Constitution does not guarantee the right to health care. The Canada Health Act outlines what under what conditions the provinces have to provide health care in order to receive federal money. The the closest we get to a guarantee, and it is an act of parliament not part of the constitution. As such it can be changed, amended or abolished by another act of parliament.



There would be hell to pay if any MP (elected Member of Parliament) was stupid enough to suggest obliterating the current Canadian Health Act.

For anyone interested, the Canadian Health Act is public information and can be found here:
http://www.parl.gc.ca/Content/LOP/ResearchPublications/944-e.htm#dtherequirementstxt

In a nutshell: The Canada Health Act (CHA) [2] is a piece of Canadian federal legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer [3]. These criteria require universal coverage (for all "insured persons") for all "medically necessary" hospital and physician services, without co-payments.

But Provincially, any and all Provincial Government websites will clearly state: health insurance is mandatory for all persons. You can check on any provincial website and they will clearly state this.

Therefore, the CHA states required universal coverage for all insured persons, and your Province Medical Services Plan states insurance is mandatory, therefore, between the 2 government bodies, the Act and the Province ensure it becomes the law.

Try to go off Provincial health care and you will be faced with legal penalties as a result.

FWIW, the Canadian Health Act is only responsible for how the system is financed. The CHA is silent about how care should be organized and delivered, as long as its criteria are met.

How the care is organized and quality of delivery is ensured by a third, independent process called Accreditation, whose sole purpose and goal: "Accreditation standards assess governance, risk management, leadership, infection prevention and control, and medication management, as well as services in over 30 sectors, including acute care, home care, rehabilitation, medical-legal records, community and public health, labs and blood banks, and diagnostic imaging."

This third party has considerable power. A hospital that fails accreditation can lose their government funding. And since in Canada it is not legal to have private hospitals (unless one has very special permissions and granting from the Federal and Provincial body), a hospital that loses it funding becomes an empty building. A Province which allows hospitals to become empty buildings loses its Federal Transfer Funding and faces severe legal penalties for failing to provide the amenities of the Canadian Health Act. Therefore, empty buildings due to failed accreditation just do not happen in Canada.

No Hospital or Public Health Service in Canada can operate without Federal Transfer money being distributed to the Province, who in turn distributes it to the hospitals so it can maintain the building, obtain equipment, medications, and staffing, and delivery a high standard of quality of care as dictated/mandated by the Accreditations. Federal Transfer money is not available unless people pay taxes. Round and round we go.

This is how our system works.

Chall
Mar. 18, 2012, 03:51 PM
Rodawn, the homeless person who gets free ER treatment, must he be a Canadian citizen?
Switzerland and Sweden have government health care, but Not if you aren't a citizen. In the US any man, woman or child from anywhere at any time gets free ER care as needed. Not at all hospitals, but nearby ones.

Tapperjockey
Mar. 18, 2012, 04:00 PM
Rodawn, the homeless person who gets free ER treatment, must he be a Canadian citizen?
Switzerland and Sweden have government health care, but Not if you aren't a citizen. In the US any man, woman or child from anywhere at any time gets free ER care as needed. Not at all hospitals, but nearby ones.

That is true. An ER cannot refuse to treat anyone. Even if they come in with a sliver or a hangnail. Citizen, non-citizen, Martian.. all must be treated.

HJAlter84
Mar. 18, 2012, 05:07 PM
Actually emergency departments are required to provide a medical screening exam and provide treatment for medical emergencies or women in labor. Most emergency departments do treat everyone but more and more are providing that screening exam and based on that exam can and do require deposits and payment of co pays prior to treatment. In those facilities don't have your 75-250 dollar copayment? Well you'll be turned away same as the uninsured. And the emergency department will discharge patients after initial treatment and refer them to appropriate specialists or gps for follow up. These referral physicians are not going to provide free care. Can't tell you how many patients come back to the Ed a few months after that first visit with the same temporary splint we put on their fracture. No money,no follow up, no cast, no surgery. Many other illnesses that could be treated out patient are not for lack of funds/insurance and those folks get sicker until they end up back with an emergent problem and then get treatment at a far greater cost. Hospital costs and in turn insurance premiums are higher to cover indigent care. Nothing in life is really free. I'd rather pay that money in taxes so that everyone can get the care they need. Spend enough time in health care and you will see it's not the stereotypical welfare abuser who goes without care, they get better than most of us with medicaid, it's the low to middle class that goes without. I doubt we will ever have socialized medicine here, not because it isnt the right thing to do but because this country is ruled by greed.

bumknees
Mar. 18, 2012, 05:45 PM
Ok thnks that make sense now..
i still dont think health care is a fundemental right.. Not that the US system is perfect it has to be reformed ... not given way not taxed, not a right and not what we have.
I did go to the Er/Ed and the Dr there was not sure if it ws boken or not, splinted it refered me to the only dr in town who doenst take my insurance. So had to go to my GP ot get refered to one that did. Instead of me jut scalling one that did. Then waiting and waiting... See if I had a PPO intead of a managed care thing I could have skipped the middle man all together..
your system where the ortho has a fracture clinic on one day sounds a lot like the way balboa naval hospital used to do it whe it was still called the pink palace one day they would have a guy who just did this then the next another guy who just did that and so on so forth.. You may or may not see the same gy twice for the same fracture.. They did the same with everything including babies.. Unless you were high risk then you saw the same guy imagine not knowing what dr you were going to see when it came time to delive your baby... mmm no sorry.. shiver.. enough to make sure I had none.. we here in the US can only hope that is not what our govt. was talking about when they mentioned using the MTF system as a basis for obama care...

FalseImpression
Mar. 18, 2012, 06:29 PM
There is a waiting period when you move to Ontario before you can get medical coverage, whether you move from outside the country or from another province. I don't recall how long it is though (3 months?). We all know all medical care is not "free" and it has to be paid somehow. Still, it is a good system which will have some shortcomings like all systems.

The migrant workers who were injured a couple of months ago in a terrible crash that killed 11 people were promised that the government would look after their medical expenses and the repatriation of the bodies of the ones who were killed. The 11th victim was Canadian. I doubt they had coverage at that point since some had just arrived and it was their first day on the job.

FalseImpression
Mar. 18, 2012, 06:34 PM
I did see the same ortho at the fracture clinic and I had an appointment time as well. Sometimes it was delayed, but most of the time, it was on time. Same thing when my husband went to another hospital for his knee and hip.. fracture clinic for initial appointment.

You all seem worried about the government deciding about your care, but you all accept the insurance cos. doing it? My doctor decides on my care, not the government. There is no government rep. that oversees his referrals/prescriptions, etc. It is between him and me.
And I see his receptionist, sometimes the nurse if I need a weigh in, and the doctor. That's it. We do not have PAs here (yet) and few practical nurses.

carolprudm
Mar. 18, 2012, 07:52 PM
You all seem worried about the government deciding about your care, but you all accept the insurance cos. doing it? My doctor decides on my care, not the government. There is no government rep. that oversees his referrals/prescriptions, etc. It is between him and me.
And I see his receptionist, sometimes the nurse if I need a weigh in, and the doctor. That's it. We do not have PAs here (yet) and few practical nurses.
I would rather deal with businessmen than politicians. Take the current birth control controversy. A politician says Oh no, might offend someone. A businessman says cheaper than an unwanted pregnancy.

saultgirl
Mar. 18, 2012, 09:01 PM
I am very grateful for Canada's health care system. There can be longer waits for non-urgent matters (although in my area there are more "walk-in" clinics or nurse practitioners opening) but it boggles my mind and breaks my heart that someone in the US could have a serious illness or injury, and possibly face losing their home and everything they have worked for...

I don't have a family doctor at this time (on a waiting list since my doc moved a couple of years ago) so I need to attend at a walk-in clinic to fill a prescription, which is kind of a pain. Luckily there is one open until 8pm some nights, so I can go in there and see the doctor. I also got my tetnus booster immediately upon asking for it, no direct cost to me.

I have additional coverage through my husband's work, so I only pay the dispensing fee at the pharmacy ($9.95). Without the additional coverage I think my prescription (thyroid meds) would be about $25 or so.

kathy s.
Mar. 18, 2012, 09:23 PM
Thanks for the info about Canada's health care system.Politicians here tend to demonize your system so it's insightful to hear from those that actually participate in it.

Is there a mandate in place that penalizes those that don't sign on to the program?

Coanteen
Mar. 18, 2012, 09:40 PM
Thanks for the info about Canada's health care system.Politicians here tend to demonize your system so it's insightful to hear from those that actually participate in it.

Is there a mandate in place that penalizes those that don't sign on to the program?

No, there isn't...signing on as you understand it in the US. There is just the one "program", and it covers every Canadian resident.
There is a wait if you move to a new province before you get established as a "resident" of that province (but if you need to go to the hospital all that happens is the province you're in and not-yet-resident will try to get $$$ out of the province where you're still officially resident). A health card is issued at birth.

If you move provinces and don't bother doing the paperwork to get a health card from your new province your "penalty" will be that an office will likely refuse to see you (or make you pay out of pocket) until you get the card, but...why wouldn't you, unless you enjoy paying out of pocket? You have no other option than the national plan anyways.

kathy s.
Mar. 18, 2012, 09:57 PM
No, there isn't...signing on as you understand it in the US. There is just the one "program", and it covers every Canadian resident.
There is a wait if you move to a new province before you get established as a "resident" of that province (but if you need to go to the hospital all that happens is the province you're in and not-yet-resident will try to get $$$ out of the province where you're still officially resident). A health card is issued at birth.

If you move provinces and don't bother doing the paperwork to get a health card from your new province your "penalty" will be that an office will likely refuse to see you (or make you pay out of pocket) until you get the card, but...why wouldn't you, unless you enjoy paying out of pocket? You have no other option than the national plan anyways.

Thanks for this info. I love my country but we have started to explore relocating to another country after I get my Phd. I abhor the thought that the USA is on a downhill slide but the way things are going, well, just the way things are going....

bumknees
Mar. 19, 2012, 07:39 AM
thank you for the information. I really do appicerate it.
the reason that some of us do fear it here in the us is because the way our govt. has handed it to us is that already a govt. office ( for want of better word) is already in the work to where they will do ''over site'' aka run it make decissions. Anyone else have a word to discribe it? It will not just be between my Dr and I it will be between my dr the govt and I. the govt. will track my health, decid to a point my health care, and decide what i need in my health care. Then allow my Dr and I talk about it to see if I should or should not continue with what the govt. says. I only know this because i've btdt with tricare.. lucky me... Which is the modle our govt. has chosen to use.
So yeah I do have a problem with it.
the Canadian system however is very diffrent than what we are told when out govt. tells us oh we will have a system just like canada or jut as efficent as canada. Then they pass a bill that some may have read but most did not have the time. I took the time to read some parts of it which is how I know hat they plan on using s the odle for most of it. the office of over site of what ever they want ot call it where appointed people make some decissions... Nothing like what you and others here have said hte canadian system is like.

One thing though ep with your script coverage for out pt scripts. Example.. I am currently on scripts tht if I did not have isurance would cost me aprox 3500$(us obviously) a month. One alone is 1200$ a mnth. Did I read correctly tht out pt or daily meds are not covered but would have to urchase a ''supplemential'' type thorugh employer/work ? And with another poster ( sorry cant remember name) can deduct upto 750$ a yr on taxes? did I read that correctly? See that would bankrupt me in probably 2mths. If like what happened with dh being unemployed for the last 2yrs except his national guard which is insurance...
Please correct me if wrong..


of course it may have to wait to next OT day.. which is ok with me if ok with you..

HJAlter84
Mar. 19, 2012, 09:19 AM
I guess I don't understand the fear of government in health care because it is already there in the form of medicare and Medicaid. Quite frankly without those programs the entire health care system would be bankrupt. These programs make up a huge percentage of hospital and physician reimbursement for services. I highly doubt for profit insurance companies want to enroll seniors with their host of medical problems en mass if the government got out of health care and if forced the premiums would be astronomical for everyone, not just seniors, to cover claims and allow for profit. I pay 500 per month for my employer sponsored health insurance and I only wish it was half as good as what the welfare recipient gets with Medicaid.
I am grateful for the limited health care reform we do have that allows me to cover my 23 yr old college educated son who goes to work 40 hrs plus per week in a company that choses not to provide health care for it's employees. And I am grateful that we have Medicare so my sister who has been diabetic since she was 10 and is now blind can get care that her husbands group employer plan denies due to it being a pre existing condition. And finally I'm grateful my coworker battling cancer could finally get on disability and get Medicare so she can get treatment without having to drag herself sick as a dog to work so she would not lose her health coverage and go without treatment or lose everything she worked for over the last 30 years to pay for the medical care she needs to survive.
This is why the repub candidates claims of moral superiority are hollow to me, greedy and uncaring is what they are. For everyone that doesn't believe healthcare is a right, well I just wonder if you would feel the same if you were injured or sick, couldn't work, lost your coverage, spent all your assets on care, bankrupted your family and still needed more care and there was none of those pesky government run programs to rely on?
After 14 years working on a trauma service and 10 more in medicine, one thing I know for sure is what we have today may not be what we have tomorrow. All of us except maybe that top 1 percent and of course the politicians who get the best Health plan for life are one accident or injury away from financial ruin and being that person who relies on government for support.

carolprudm
Mar. 19, 2012, 10:20 AM
I guess I don't understand the fear of government in health care because it is already there in the form of medicare and Medicaid. Quite frankly without those programs the entire health care system would be bankrupt. These programs make up a huge percentage of hospital and physician reimbursement for services. I highly doubt for profit insurance companies want to enroll seniors with their host of medical problems en mass if the government got out of health care and if forced the premiums would be astronomical for everyone, not just seniors, to cover claims and allow for profit.

Actually private insurance companies are quite happy to issue supplemental Medicare insurance. There's a LOT that Medicare does not cover. Some but not all of that is covered by Medicare supplemental insurance.

If certain congressmen have their way Medicare will be replaced by a voucher system

bumknees
Mar. 19, 2012, 10:20 AM
I have had govt. insurance in more than one form. for the last mmm 27 yrs of my life. I have had more than my fair share of tramatic illnesses. but yet when i did have non govt. insurance I was not denied due to preexisting conditions. And trust me while not diebeties(sp) an until the last 2ish yrs not a weird form of non fatial cancer actually 2 forms of it.
But even after having one very tramatic illnes which required to save my life a very very nasty tramatic surgery of which I had something like a 15-20% chance of comming out of it not dead or a vegi... Not very good odds..
I have not been denied coverage by civilian insurance. But oddly enough when I would have a test that is given to anyone with brain activity or a pulse I was informed i was not in the correct age group.. And that was under govt. insurance... Oh yeah last i looked alive was in the correct age group for an EEG... But the govt. said nope not in correct age group..

And yeah i know what govt. insurance pays compaired to civilian insurance.. There is a reason dr's do extra testing when it is not necessary when they have people who are on tricare, medicade, etc.. because of what they pay... They have to cover their costs somehow. IE a regular annual for a female about 6 yrs ago.. Done at GP not GYN office. including supplies, lab dr visit everything for the anual pap etc. the bill was 250$ Tricare ( military dependent insurance) paid a whole 54$ that was to the lab, and to the Dr that was their total pay out for the entire visit and testing... yeah wonder why people are against govt. insurance.. Oh yeah they claim that is 80% of the prevailing cost of the area. And I am told medecaide(sp) pays out LESS.. Imagine what obamacare would pay out more peole less funds to pay the drs with... Or perhaps they would say nope you dont need it so you dont get it.. aka rationing of health care...

but back to topic on thread...

eclipse
Mar. 19, 2012, 10:25 AM
Here in Alberta, we have no provincial sales tax but do have the GST (federal). Our Alberta Health Care is also something that we do not pay for anymore, but I believe we should as the gov't is making cuts to healthcare, and if we were paying as before this would help (lower incomes were always exempt anyway!).

But, on the other hand, I have never been refused treatment or had to wait an exorbant amount of time. For instance, I shattered my radial head and was in for surgery with the orthopedist on call the next morning (stayed in hospital for 4 days total and had home help if I'd needed it).

My sister was diagnosed with Hodgkins a week after her first child (her shoulder swelled) and when she went to see her dr about it, they had her in treatment that afternoon! My mom was diagnosed with breast cancer and after her mammogram went the next week for a biopsy (they couldn't find it) so was scheduled for a lumpectomy 2 weeks after diagnosis. The continued with her cancer treatments immediatly. It's my opinion that the true emergencies are still being seen fairly fast, and I really wouldn't want to be the one that has to make the decision of which gets seen first.

To see my dr for a yearly exam, well I have to wait a little as he's booking them 1-2 mths out. If I'm sick or need to see him regarding my migranes of which he's treating me I can generally get an appointment that same day (although when I had something that could of been very serious, they pushed me in that day!).

I also have full benefits from my employer, that covers dental, prescriptions, massages etc. I do pay a very small amount every month, but we also have a health spending account that can cover anything not covered by our benefit plan or you can actually use to pay the portion that the employer does not pay (very common in Calgary). We also have Long Terms and Short Term disability that kicks in after we use our paid sick time (we have 10 working days).

FalseImpression
Mar. 19, 2012, 10:38 AM
No, there is not a $750 limit to claim your medical expenses in your tax return. I think what the poster meant was "anything over $750". It was a lower limit. It may vary from province to province as health is a provincial matter (even with the transfer payments explained earlier).

I know I claim anything I have a receipt for (eye exams, dentals, prescription drugs, etc). I don't get a straight deduction, but a certain percentage. I never understand how government bureaucrats figure out the calculations.

Also, lately, due to cutbacks, some procedures are being delisted ie won't be covered any longer by the government. ie eye exams used to be once a year, then once every two years for people between 19 and 65. Now I don't even know. I still go every year any way... out of pocket.. but I claim it.

rodawn
Mar. 19, 2012, 11:55 AM
thank you for the information. I really do appicerate it.
the reason that some of us do fear it here in the us is because the way our govt. has handed it to us is that already a govt. office ( for want of better word) is already in the work to where they will do ''over site'' aka run it make decissions. Anyone else have a word to discribe it? It will not just be between my Dr and I it will be between my dr the govt and I. the govt. will track my health, decid to a point my health care, and decide what i need in my health care. Then allow my Dr and I talk about it to see if I should or should not continue with what the govt. says. I only know this because i've btdt with tricare.. lucky me... Which is the modle our govt. has chosen to use.
So yeah I do have a problem with it.
the Canadian system however is very diffrent than what we are told when out govt. tells us oh we will have a system just like canada or jut as efficent as canada. Then they pass a bill that some may have read but most did not have the time. I took the time to read some parts of it which is how I know hat they plan on using s the odle for most of it. the office of over site of what ever they want ot call it where appointed people make some decissions... Nothing like what you and others here have said hte canadian system is like.

One thing though ep with your script coverage for out pt scripts. Example.. I am currently on scripts tht if I did not have isurance would cost me aprox 3500$(us obviously) a month. One alone is 1200$ a mnth. Did I read correctly tht out pt or daily meds are not covered but would have to urchase a ''supplemential'' type thorugh employer/work ? And with another poster ( sorry cant remember name) can deduct upto 750$ a yr on taxes? did I read that correctly? See that would bankrupt me in probably 2mths. If like what happened with dh being unemployed for the last 2yrs except his national guard which is insurance...
Please correct me if wrong..


of course it may have to wait to next OT day.. which is ok with me if ok with you..

To tell you the truth, I really have no idea what model of system the US is planning on using so I can't really answer your question. We heard via our news media, that your government spoke with Canada, but also France, Switzerland and England about their health care systems, which also provide universal coverage to their citizens, but they're all a little different than Canada's and have different systems in place.

All I can is explain what we do here in Canada so that there is no fear mongering about the Canadian system. Knowledge is power! Half my family is American and we discuss this all the time... Americans need to get really informed about this and take an active role in the decisions for your health care system or you'll never be happy with the model your government finally implements. From what my family has told me, there is a lot of fear mongering going on, which is just wrong, and my family members are not clear yet what system model is being discussed. My query is - How can people make informed choices if they're bullied and fear mongered by untruths by elected people they're supposed to be trusting?

In Canada, the government has no interference in the health of the Canadian.

There is a tracking system - but that's how each Province gets appropriate funding. There has to be a tracking body in place to know how much the system is costing each Province on an annual basis. If we know the average, then the province gets their funding according to their averages. Based on population, usage of the system, and any number of other factors. It's also a way of preventing abuse by the Provinces to get more money than they really need, and a way of keeping expenses in check because, like anything, finances can get wildly out of control, so there do have to be checks and balances in place. This is a normal process in any business, let alone the government which should be run like a very large corporation anyway.

That tracking system, however, is not there to boss or bully or control the patient into how, when, where or why they see their doctor.

The USA's HIPAA Laws just passed in about 2009 or thereabouts should prevent this. The HIPAA Law was passed to require stringent controls and regulations surrounding the confidentiality of each patient's medical records. While originally put in place to prevent contracting out of legal medical records services to offshore countries it also applies in-country. Your medical records are guarded documents of private information.

It's the same in Canada, if your mother is not allowed to see your medical record, then you can be sure that no government official is allowed to see it either. YOU in the presence of your doctor or nurse or other witness, have to provide signed consent and nobody can bully you into providing that permission. THIS IS LAW. I'm a medical records legal expert and so I know this inside, out, backwards, and upside down. If for some reason, someone thinks that your refusal to release your record is a matter of legal priority for some reason, they would have to fight it out in court. The judges are automatically on the side of the patient and would have to convinced beyond any shadow of a doubt that it is required. And that's the only way your records could ever be released.

Funding parameters are achieved by assessing non-identifying parameters within your medical chart by certified personnel - called Coders - all they gather is information about what services were accessed by the public in general. This information is used to get funding. This is the only information the government can see. I know all this because as part of my job, I am required to be a medical-legal records expert. Personally identifying information is NEVER released. To anyone. For any reason. Short of a judges court order and even then the patient knows and is fully informed about it and has participated in the process already.

This system is in place in the USA also, so any politician that fear mongers the public by stating your records would be open to the government with detailed information about you and services you accessed, is wrong. I have also worked in the same capacity as I do now up here in Canada for several major hospitals in the USA. Your laws in the USA are already strongly in place that protects the privacy and confidentiality of all patients. Non-identifying information might be available - by non-identifying information I mean exactly this: that in Community, State, at XYZ Hospital, there were 4025 people who accessed a CT scanner for X purpose, 26,800 people had X_Y type of X-rays. 505,500 people accessed lab services for Z2345 test and 1,250,000 people attended the ER in the year 2011. That's it.

As for medications, the Canadian system tends to subsidize our medications, so they are substantially cheaper here than in the US. Also, there are various programs in place to help a patient if they cannot afford their medications. If a patient finds themselves in a financial bind they can go back to their doctor and the doctor can enlist the help of several programs to help you with funding. Elderly people on fixed pension incomes are also discounted even more to make it affordable for them. For someone who is temporarily out of work due to illness or was laid off, if they cannot afford their medications and they speak to their doctor about it, the doctor can refer you to Social Work who has access to funded programs that can help. So the key to the system in Canada is you enlist the help of people your coverage covers - your doctor, your ER doctor, your Nurse Practitioner (Alberta has those) and THEY in turn have access to various resources and funded programs you wouldn't necessarily know about.

MOST Canadians do not seem to know about the various satelite programs out there that are satellites, if-you-will, to the current health care system. They see the hospital and thinks that's where all the tax dollars are going for their medical system. But it's not! There are hundreds and thoussands of satellite medical programs that are also funded and all these things work together to provide each Canadian good care. You access these programs on a need-to-know basis on a case-by-case basis - mental health programs, social based programs, all covered by your basic health care. The basic point of these extra access programs is so people CAN get their medication that is Rx'd by their doctors. We don't want people going bankrupt or chosing not to eat versus getting their medications. We want you to be able to do both! In the eyes of our system, it is far more expensive to treat a patient who lands up in hospital because they CAN'T take their medications, than it is get social program funding so you can continue to take your medication as an outpatient and just visit your doctor periodically. Understand?

Our basic medical doesn't cover EVERYTHING. If you need to see a physiotherapist or accupuncture, massage therapist, or accupressurist because you slipped and fell on ice, not seriously injured, but say just wonked out your back, those treatments are not covered. An ambulance trip is not covered. If you had a skiing accident and had to be air transported to hospital, such as by STARS (helicopter ambulance) in Alberta, that's not covered. But this is why extra insurance programs like Blue Cross are available. Blue Cross also is available in the USA. You need to see their website to see what programs are available, but up here, the program we have is to cover vision, dental, 80% of medications, extended health (Physio), travel insurance for out of province or out of country, and the extra cost of a private hospital room if I want it.

A LOT of employers in Canada pay for the basic medical plan coverage as part of their benefits. Not all employers, but a lot do. The really good employers also cover your Blue Cross, plus provide access to other insurers that cover you should have catastrophic injury and lose a limb, eye, or what have you. I also have access to that because of the nature of my work in the Alberta Health Care System.

rodawn
Mar. 19, 2012, 12:37 PM
Rodawn, the homeless person who gets free ER treatment, must he be a Canadian citizen?
Switzerland and Sweden have government health care, but Not if you aren't a citizen. In the US any man, woman or child from anywhere at any time gets free ER care as needed. Not at all hospitals, but nearby ones.

Nobody can be turned away from any hospital regardless if it is a major trauma centre, or as simple as a walk-in clinic.

A homeless person would usually be a Canadian citizen, but if they have no income, then there are certain social programs that come into play when a homeless person needs to see the ER. This is all done in the background and frankly the homeless person would probably not even be aware of it. The clerical staff have all their procedures in place and know what to do should someone arrive for help who isn't a citizen, or who doesn't have their insurance card.

Let's be frank, a homeless guy probably doesn't have his health card on him, but he is still cared for and the staff just do up the paperwork for the guy while he is being treated in the ER. In Alberta, it's a bit easier because nobody has to pay a monthly premium, but an Alberta resident still needs to have an Alberta Personal Health Number, even if your 'home' is on the streets downtown Calgary. Your number is unique to you and that is because you must have continuity of record keeping so treating physicians can access your history.

It's a bit more problematic for a noncitizen living here illegally - they still get care, but then Social Services has to be involved and it's gets a little complicated for a forum.

Your question also brings up the point of travellers: Anyone travelling to Canada should always buy travel insurance. Then if you're in an accident, your care is covered by that insurance. Your family might have to fill out some forms, but the priority is that you the patient not worry about these things and just get treatment.

FalseImpression
Mar. 19, 2012, 12:57 PM
Rodawn, you explain the system so well. Thank you.
Things are pretty similar in Ontario. Also I wanted to say that, even if ambulance service is not covered, we do not get a $700 bill for a short trip. It is still very reasonable!! And, again, you can claim that expense.

Re the French system. I was born in France but left in 1974 and have not really kept up with it. I was just talking to my mom about it and found out that it really is not quite as good as the Cdn system. Ex.: my nephew is turning 21, not working but not in school full-time either (distance ed), not living at home. He has NO coverage at all. He does not pay the dues from a pay cheque, tuition and his dad does not cover him any longer. That would not happen in Canada. He still would be covered.
In France, people pay first and get a refund (and they have changed the % on appointments, hospitals, meds, dental, eyecare, etc.). It is a nightmare to really understand how much is covered. There are private clinics/hospitals but they can't really charge more than the public hospitals.

My mom is 88 and has total coverage for some meds, treatments (related to macular degeneration for ex.) and diabetes. However, some meds she has to pay "something" for, but she also has extra private insurance. I think I still like the Cdn system much better.

And yes, I always carry private insurance (CAA) when traveling to another province/country. It is the smart thing to do!!

Windsor1
Mar. 19, 2012, 01:02 PM
I would rather deal with businessmen than politicians. Take the current birth control controversy. A politician says Oh no, might offend someone. A businessman says cheaper than an unwanted pregnancy.

See, I feel the opposite. A businessman's number-one priority is taking care of the bottom line, right? I don't want someone in that position making decisions about my health care. Talk about a conflict of interest.

rodawn
Mar. 19, 2012, 01:17 PM
See now I wouldn't want either involved in my health care. And that's because I'm Canadian. Nobody is involved in my health care or the decisions based therein, except me and my doctor. Period.

Windsor1
Mar. 19, 2012, 01:45 PM
See now I wouldn't want either involved in my health care. And that's because I'm Canadian. Nobody is involved in my health care or the decisions based therein, except me and my doctor. Period.

I think it goes without saying that no one WANTS either politicians or businessmen making or influencing decisions about their health care. But if I have to choose between the government being "involved" in the sense of providing a single-payer system and a business being "involved" in terms of private insurance carriers, I'd take the government, for the reason I cited.

eclipse
Mar. 19, 2012, 02:25 PM
I think it goes without saying that no one WANTS either politicians or businessmen making or influencing decisions about their health care. But if I have to choose between the government being "involved" in the sense of providing a single-payer system and a business being "involved" in terms of private insurance carriers, I'd take the government, for the reason I cited.

But you see, that is the issue that we as Canadians can't fathom out with the USA. You think because we have a subsidised national health care, that the Government IS involoved. It isn't...really! They provide funding, as described by RoDawn and they have ABSOLUTELY NO SAY in treatments that are discussed between dr and patient! If my dr, decides that he would like me to get a CAT scan or MRI for my migranes, guess what, I get it, no questions asked. When I fall off my horse and break a bone, I get treated, only questions asked are "how did this happen" and other DR/NURSE imposed questions so that they can treat me properly.......NO Gov't or insurance interference!

It really isn't the big bad "big brother" system that a lot of American's think it is! It's actually pretty fantastic. :D

carolprudm
Mar. 19, 2012, 02:54 PM
But you see, that is the issue that we as Canadians can't fathom out with the USA. You think because we have a subsidised national health care, that the Government IS involoved. It isn't...really! They provide funding, as described by RoDawn and they have ABSOLUTELY NO SAY in treatments that are discussed between dr and patient! If my dr, decides that he would like me to get a CAT scan or MRI for my migranes, guess what, I get it, no questions asked. When I fall off my horse and break a bone, I get treated, only questions asked are "how did this happen" and other DR/NURSE imposed questions so that they can treat me properly.......NO Gov't or insurance interference!

It really isn't the big bad "big brother" system that a lot of American's think it is! It's actually pretty fantastic. :D
I doubt our congress would be able to keep their hands off.

Maye you don't have the powerful right wing anti choice lobby we have. We have the Hyde amendment. No federal money can be used for abortions. This means that military and federal employees, even though they also contribute to their health insurance, do not have any coverage for aortions. Medicade also cannot cover them. Some extreme groups also want to exclude BCP's and IUD's.

ETA: I think our congress has about a 15% approval rating

Tapperjockey
Mar. 19, 2012, 02:57 PM
But you see, that is the issue that we as Canadians can't fathom out with the USA. You think because we have a subsidised national health care, that the Government IS involoved. It isn't...really! They provide funding, as described by RoDawn and they have ABSOLUTELY NO SAY in treatments that are discussed between dr and patient! If my dr, decides that he would like me to get a CAT scan or MRI for my migranes, guess what, I get it, no questions asked. When I fall off my horse and break a bone, I get treated, only questions asked are "how did this happen" and other DR/NURSE imposed questions so that they can treat me properly.......NO Gov't or insurance interference!

It really isn't the big bad "big brother" system that a lot of American's think it is! It's actually pretty fantastic. :D

How does it work if you and your doctor disagree on something though, such as a course of treatment?

eclipse
Mar. 19, 2012, 03:27 PM
How does it work if you and your doctor disagree on something though, such as a course of treatment?

You have every right to go to another dr for a 2nd opinion. Your family gp is not assigned to you, you pick! And, I once had an orthopedic surgeon that I just did not like or feel comfortable with. I just requested another dr through the hospital administration and voila, done!

Now, if you are an underage child and your parents are refusing treatment for you that will save your life (ie, chemotherapy, blood transfusions etc), then there have been cases where the dr's have gone to the province to force the parents to allow treatment. It's a very contentious area, doesn't happen a lot, and is big news when it does. (BTW, I believe the dr's have always won!)

If you are an adult, of sound mind and body, you can of course, refuse any treatment offered! To avoid any misunderstandings on my behalf, I have it written into my will (so does my husband) the instances of non-resusitation and taking us off life-support.

Carrera
Mar. 19, 2012, 03:38 PM
How long is the waiting time in Canada to:

See a doctor for a routine check up? I have to drive an hour and a half to see my doc. She's booking 3 weeks ahead right now

See a doctor for something non-life threatening? (like chicken pox or something)? Same as above

Schedule surgery for something non-life threatening (like a hip replacement, etc)? Wait months to see a specialist then they decide. I had a TBI and didn't see the neuro doc for 4 months after the injury, and has seizures

Schedule cancer diagnostics and treatment for a 70 year old person (or older)?

It has been said by others here in the U.S. that people come here from Canada all of the time because they cannot get the treatments that they want or need in a timely fashion up there. It would be good to know if the things that I have heard are true.

There is a YEAR long wait list for a dr in my town. I broke my foot last year waited 5 hours in the er. Got an X-ray and was told that yep its broken. Not to ride for a week, no pain meds given and I had to ask if they should cast it. I have such a hard time now with that foot. I need orthotics but because I don't have health insurance it's over $400.00 for them that I just don't have. Plus my meds a month are close to $130.00.

LittleblackMorgan
Mar. 19, 2012, 04:13 PM
I could be wrong but it seems that we in the US, especially Massachusetts (where we MUST have health insurance or we get a huge tax fine), are getting it from both ends.

I pay $1200 a month for health insurance, and they can still mandate what they will and wont pay for. ER costs me $150 a visit out of pocket. We pay a copay on prescriptions of up to $50 but no lower than $20.

If I chose to have my baby in a certain hospital (or Mass general, or Children's in Boston), on top of the 1200 a month, we have to pay 3k out of pocket before insurance will even kick in.

As far as taxes, we pay (before write offs) around 30k. Plus property tax on the house, excise tax on the cars and trailers, sales tax on everything but food (unless you eat out) and we can't write off medical expenses unless its 20% of our income (I think, I might be wrong on the percentage).

HOWEVER-
My sister is on gov't insurance. She doesn't work, hasnt worked for her whole life and she is late 30's. Guess what? She got to deliver her baby at Mass General for FREE, her meds FOR FREE, her tubes got tied FOR FREE. She goes to a bazillion of the best doctors in the country FOR FREE.

And I bust my ass working and have to pray my kid doesn't need to go to Mass General for complications because I don't think I can afford it.

What's wrong with this picture?

rodawn
Mar. 19, 2012, 05:28 PM
I doubt our congress would be able to keep their hands off.

Maye you don't have the powerful right wing anti choice lobby we have. We have the Hyde amendment. No federal money can be used for abortions. This means that military and federal employees, even though they also contribute to their health insurance, do not have any coverage for aortions. Medicade also cannot cover them. Some extreme groups also want to exclude BCP's and IUD's.

ETA: I think our congress has about a 15% approval rating

Your country certainly has some hurdles. (Don't we all!) I would think the first order of business to set this up is to disallow any one interest group the right to interfere with anyone's medical care. Until that's definitively dealt with in a most emphatic way, you're going to have some major problems with whatever health care system you finally decide upon.

FWIW, Canada's setup into our current medical system didn't just arrive overnight. It took quite a while to get it to where it is today. The idea or inception started over 40 years ago. During this time, many changes, tweaks and whathaveyou were made.

The best thing any country can do is start somewhere because you can always tweak and amend as needed. BUT, it has to work for YOUR country according to YOUR ideals and values as a country. A Made In Canada healthcare system just might not suffice for the USA. If you can take ideas from your current system and several other systems, tweak it, rearrange it, and make it your own, it will be better for Americans in the long run. All Canada can do is show you what works for Canada, England tells you what works for them, France tells you what works for them... but in the long run, the USA has to set up what works for the USA and make it a Made In USA solution to USA problems. It won't be perfect at the start, far from it, of this I have no doubt, but you can always revisit it later as many times as you need and tweak.

I just think it's kinda unrealistic to expect your current system to morph into something perfect in the next couple years. It took us 40 years. And we're still tweaking it. So, just sayin'...

No Canadian can tell you "oh well, ours is perfect, we love it, so should you"... because Canadians are...well.... Canadians. We're a different people, different country.

You have a wonderful thing called Freedom of Speech and so use your Voice and send your opinions to your politicians. Tell them to behave and start working together for the sake of the entire country! You the people have the power. Politicians like to think they hold it all, but really, it's you people who can fire their sorry a$$ for misbehaving.

I hate it when politicians behave badly... they do it all the time up here too... and the thing is when they're all bickering, bitching, whining and complaining and pointing fingers and playing the blame game, it does NOTHING for the country. The political floor is a bit like an elementary schoolyard. :lol:

rodawn
Mar. 19, 2012, 05:49 PM
If you are an adult, of sound mind and body, you can of course, refuse any treatment offered! To avoid any misunderstandings on my behalf, I have it written into my will (so does my husband) the instances of non-resusitation and taking us off life-support.

I have always believed everyone should have 2 extra documents in addition to their Will:

(1) Power of Attorney which covers your legal and monetary affairs and directives should you become incapacitated or mentally unstable.

(2) Personal Directive or a Medical Power Of Attorney which defines exactly what you want in terms of medical care should you become incapacitated and cannot speak for yourself. You decide in explicit terms whether you want full life support indefinitely until proven brain dead or for a specified length of time or how much medical care you want in given situations, what level of care you want, how much medical support, equipment support, resuscitative support, or whether you just want comfort measures to keep you comfortable until you pass.

Piaffe11
Mar. 19, 2012, 06:11 PM
I for one am very thankful for OHIP. I have had 2 major surgeries in my life and have had many treatments for my auto-immune disease. Without OHIP (even not paying the full cost with a supplement insurance) I would be broke with hospital bills.

One of my auto-immune treatments was $20 000 a day (of which I had two) - I paid nothing. My hematologist decided I needed a spenectomy (for said auto-immune disease) - I saw my surgeon within a week and the surgery was booked for 2 weeks after that. It was not a straight out emergency operation...

Even my family doctor will see me within a week for a non-emergency and the same day for emergencies. When I was diagnosed with my auto-immune disease he waited for the blood results and called me back immediately with the unfortunate results (at 10pm).

I know not everyone has the same experience in Ontario, but I have never had any reason to think our health care system isn't running as smoothly as it can with the funds given to it.

Just my $0.02 ;)

rodawn
Mar. 19, 2012, 06:43 PM
There is a YEAR long wait list for a dr in my town. I broke my foot last year waited 5 hours in the er. Got an X-ray and was told that yep its broken. Not to ride for a week, no pain meds given and I had to ask if they should cast it. I have such a hard time now with that foot. I need orthotics but because I don't have health insurance it's over $400.00 for them that I just don't have. Plus my meds a month are close to $130.00.

Don't know where you are, but most provinces implement a triage system in the ER. A person with a broken foot is not going to get seen before a severe asthma attack, a cardiac arrest or MVA victim, and ambulances and Air Transport Ambulances, and people gushing blood will always take priority over people who can still walk (or hobble) and breathe and talk relatively comfortably. Part of this problem is a lot of people abuse the ER and go to be seen for a cold. A person with a cold is going to be seen last out of everyone and you're going to sit there a very long time - just go to a walk-in clinic already!

Rural/small town places have a hard time finding doctors. There aren't as many people going to medical school as there once was, or nursing school. If we could encourage more people to go to medical school and nursing school it would help, a lot.

Elective surgical wait times is the hot button topic being discussed everywhere - but this is for ELECTIVE surgery. Not emergency or priority surgery. Emergency surgery is done immediately. Priority surgery is next in line and is booked within hours to days depending on the situation and health of the patient. Elective means you can wait because it's not emergent, life-threatening and it's technically an optional surgery.

Sometimes, a province will opt to pay for special treatment found in the US because the physician has unique specialized training/skills and can perform the treatment for someone with a very unique, usually rare genetic condition. Some individuals choose to pay their own way and zip down to the US for elective surgery and pay out of their own pocket. Naturally the US doc doesn't mind the extra income to perform an elective surgery that was purely optional for the patient.

Donella
Mar. 19, 2012, 08:11 PM
Rural/small town places have a hard time finding doctors. There aren't as many people going to medical school as there once was, or nursing school. If we could encourage more people to go to medical school and nursing school it would help, a lot.

Med school is still super competative, there are tonnes of people applying. My good friend just had her interview on Saturday at the U of A and there were, I think she said, over 400 people going through the interview process (way more than that applied obviously). I just think most people don't have a desire to go through med school and then live in the boonies as a GP.

My sister's best friend just passed away a few days ago, at TWENTY NINE years old because the mole she had biopsied a few years ago was diagnosed as benign when it was really malignant. One of my clients is a very successful medical malpractice lawyer and you can't even believe how many similar stories she has. All in the same city, ect ect. Maybe this happens just as often in the US but in my mind, something is seriously missing when people routinely die because there are no safeguards in place against simple human mistakes (which happen even more frequently when people making life and death decisions are allowed to work too many hours).

Coanteen
Mar. 19, 2012, 08:24 PM
Rural/small town places have a hard time finding doctors. There aren't as many people going to medical school as there once was, or nursing school. If we could encourage more people to go to medical school and nursing school it would help, a lot.

Med school is still super competative, there are tonnes of people applying. My good friend just had her interview on Saturday at the U of A and there were, I think she said, over 400 people going through the interview process (way more than that applied obviously). I just think most people don't have a desire to go through med school and then live in the boonies as a GP.


That rural med school they opened in Ont is trying to address it.
But yes, it's a matter of getting docs to go to small/rural towns. It's not just living in the boonies - it's knowing that as a GP in the boonies you'll also have less support from specialists, that you'll be expected to be on call more because there are no after-hours walk-in clinics to take the load off. In many small towns the GP's run the ER as well (and sometimes the impatient ward too), and many aren't comfortable with that. It's knowing that if you're one of very few physicians taking vacations will be hard - you'll be leaving your patients with few options. It's knowing that your SO might have a hard time finding a job. All that stuff. What is the incentive for a GP to move to a small rural town to practice, vs staying in a bigger city (and many towns of course try to financially incentivize GP's)?

FalseImpression
Mar. 19, 2012, 09:44 PM
You don't have to live in the boonies to have a shortage of doctors... I live in Kitchener/Waterloo, just one hour west of Toronto, and we have a shortage. the reason given by doctors was "no medical school, hence no university hospital"... but we have great specialists, Toronto, Hamilton and London are all about one hour away and it is not impossible to refer to those hospitals if needed.
I understand the reluctance of going to the Great White North, I mean, real rural communities, but in Southern Ontario? Come on... I have always been lucky that I have a family doctor and when he retired, he made sure his practice was taken over and his clients looked after.
Competition is strong to get in to med school, but then, I think new doctors want their cake and eat it too. Toronto has many doctors and I know of quite a few programs to encourage doctors to move out to other communities (forgiving of part of loan repayments, tax credits in the cities, etc.)
However, I don't hear of as may doctors deciding to go down to greener pastures in the US any more, and many, many have come back. Richer maybe, but totally disillusioned after working with/for insurance companies.

LarkspurCO
Mar. 19, 2012, 11:53 PM
You all seem worried about the government deciding about your care, but you all accept the insurance cos. doing it?

Insurance companies don't decide on patient care. They only set the fee schedule for payment of that care.

If I don't like my insurance coverage, I can shop around for a different plan (would be nice if I could buy across state lines). With nationalized health care, there is no competition. You get what you get.

FalseImpression
Mar. 20, 2012, 12:53 AM
Insurance companies don't decide on patient care. They only set the fee schedule for payment of that care.

.

Then why do I keep reading "my insurance denied this or that", "my insurance will not accept this doctor or this hospital"? That, to me, is interfering with the care.

Tapperjockey
Mar. 20, 2012, 01:12 AM
Then why do I keep reading "my insurance denied this or that", "my insurance will not accept this doctor or this hospital"? That, to me, is interfering with the care.

The insurance doesn't deny you the treatment. There are things that they may not pay for, .. which is why their are different companies and plans.

bumknees
Mar. 20, 2012, 07:24 AM
HIPPA is not necessarly the privacy thing that comes from the privcy act of 197something... Which is shakey at best both or them.. Which also comes along our wonderful federal reduction of paper use act which of course not everyone got on board with... turst me when someone sneezes we get a butt load of PAPER... And there are ways around the Privacy act... I often wonder how smeone in one office in another state was able to gain access to my medical records from a federal hospital with out me signing a release form... Those only on the computer... those on paper are lost somewhere or actualy in all fairness about 1/3 of them the rest got edited...
As for the paper reduction at yeah tell that to Walter Reed vs Bethesdia( before the merged not so long ago) one went paperless the other did not... which is probably why they merged..Or as the govt put is ''realigned''

But yeah a civilian dr who had no military connection who Im not even sure was alive or if he was was quite young when it occured had ''found'' my on computer my medical records from Walter Reed... So much for privacy... So much for checks and balances so much for the govt making sure noone saw things that I did not authorize... Not that I was hiding anything. heck I had hard copies in my hand to give to him when I had my first apt with him... No need to he had it already. Oh yeah the WR records are not kept under MY SS# but my dh's with a prefix...
The oly way he could have gained access to them is if the govt had a hand in it or gave permission of just ''handed '' them over. Yeah I can trust my govt. to keep things private.. much like I can trust my dog to drive a vehicle safely...

It isnt so much that the insurance doesnt accept the Dr but the Dr doesnt accept the insurance. Ie he doesnt have a contract with the insurance to accept with they pay. For example Dr charges you <keep math simple> 100$ for the apt you have. You insurance will pay 80% of the prevailing charge for the area which is lets say 50$. So instead of paying the dr 80$ they will pay 40$ which will leave the pt (you) to pay the additional 60$ out of pocket instead of the 20$ left over of the original 100$. But yo ucan still see what ever dr you wish. It just means you are responsible to pay what is left over after the insurance pays.
If hte Dr accepts your insurance we accepts what they pay and you may or may not be responsible for the let over depending on if your annual cap aka out of pocket expense is met or not. But once your cap is met the insurance pays 100% of pervailing charge and you have no more out of pocket. Except maybe scripts. i have not experianced scripts coverage yet with civilian insurance so cant help in that catagory..

i do agree our system has to be reformed. I think some of the barriers have to be removed to allow more competition between the companies that would drive costs down. I also think that maybe an ala carte type insurance thing maybe an idea because for example why do guys have to pay for coverage for obgyn when clearly they do not need it?
I just do not trust our govt. to handle things as private as my health. BTDT and if I can help it never again it was not plesent when I had to...

but I do thank those who took the time to go into wonderful detail on the Canadian system. I am happy it works for the most part in your country. And yes I hope it continues ot work in your country as I think the moment it stops working and hte govt. has to shut it down ther e will be major problems up there. Which I dont wish on anyone.
But honestly I dont think it will work here. As many including myself do not believe it is a right. A comodity yes right no. Can it be cheaper and more affordable yes.

Windsor1
Mar. 20, 2012, 07:27 AM
Then why do I keep reading "my insurance denied this or that", "my insurance will not accept this doctor or this hospital"? That, to me, is interfering with the care.

It is to me too. A choice between going without needed care or bankrupting yourself to pay for it out of a pocket is no choice at all.

CatOnLap
Apr. 7, 2012, 10:56 AM
Rural/small town places have a hard time finding doctors. There aren't as many people going to medical school as there once was, or nursing school. If we could encourage more people to go to medical school and nursing school it would help, a lot.

In fact, the number of people going to medical school in Canada has DOUBLED over the past ten years in an attempt to correct the government created shortage of doctors that happened in the 1980's when the government decided that doctors were too expensive,so they arbitrarily cut enrollment in half.

Many solutions have been proposed for the rural shortage, but it boils down to this: rural practice is unnattractive, with inhumanely long hours, little to no time off and little collegial support. I worked as a doc in a town of 50,000- hardly a small town- but rural- the nearest major medical center was more than 2 hours drive away. I got really burned out by patients calling me at home at all hours, being called into the small rural hospital on my days off because there was no one else, and by being the most educated, most senior doc in my area, so that all the other docs relied on me for consultation but I had no one to turn to without calling up the big city experts. All this, and I got paid no more than my city cousins who took call once in 30 days and got to sleep nights, attend lectures every week, etc. I left after 2 years and now practice in one of the largest cities in the country. These factors are not compensated for by the new rural premiums where new docs can only bill the system 80% of the fee schedule if they practice in a city and can bill upto 120% if they are in a remote area. Burnout and your health is not worth the money.

People in Canada have a right to be worried about our health system. About 50% of our doctors are set to retire within the next 10 years as most of us are now over the age of 55. Most of my younger colleagues, age 40 or less, are seeking ways to get out as well. Government payment is not keeping up with inflation and the work hours are getting worse. I make less than a police sargeant or a high school principal, and am at greater risk for injury in my work than either of those two, plus I have no medical benefits, insurance or pension plan as is provided for both of those occupations! My electrician and my auto mechanic both bill a comparable hourly rate and neither one had to go through 12 years of university first. Being a doctor, frankly,stinks financially these days and stinks in a lot of other ways.

Most of us docs pay privately for at least some of our medical care. When I was crippled with a knee injury, I wasn't going to wait more than a year for my scheduled public MRI- I paid the $1200 to go down to Washington state and have it done the next day.

In my province,25% of people do not have a family doctor and cannot get one even in the largest cities. They rely on walk in clinics: spotty care, which is why diagnoses are being missed. My friend with breast cancer waited nearly 8 weeks to begin treatment and eventually died from her disease. Last time I went to Emerg with a possibility of a spinal decompensation and escalating neurological symptoms- considered a medical emergency-I waited on a stretcher nearly 12 hours before being seen. Typical waits to see a specialist are 6-12 months or more. Typical waits to have a knee or hip replacement are another 6-12 months after you see the specialist- and if you are a woman and want a woman sized joint replacement, you pay privately for it as the system only provides one option and it is sized for men.

I pay privately for all my dental, disability, pension, and non emergent medical needs. Health care in Canada is far from free and yes, our taxes are about 20% higher than in the USA, plus, our mortgages are not tax deductible as they are in the US.

Blugal
Apr. 7, 2012, 12:00 PM
I pay privately for all my dental, disability, pension, and non emergent medical needs.

This is what my thread was originally started for - I am shocked that you as a doctor are also paying privately for these things.

carolprudm
Apr. 7, 2012, 01:16 PM
Then why do I keep reading "my insurance denied this or that", "my insurance will not accept this doctor or this hospital"? That, to me, is interfering with the care.
An insurance company can deny a treatment that is not FDA approved or they feel is not necessary. This can be appealed...I have been successful with my two appeals. In some cases the insurance company might want you to try a generic drug rather than the name brand. After my hysterectomy I was put on generic estrogen patches which made me itch. When I explained the issue I was switched to the name brand though i did have a higher co pay.

I think I paid $25 for the tube of Regranex when the incisions and fracture blisters on my ankle wouldn't heal....list price, hang on to your hat
http://www.aafp.org/afp/2008/0715/p255.html
almost $600. Insurance company had NO objection.

It is usually not a case of an insurance plan not accepting a doctor or hospital but rather the doctor or hospital deciding that the insurance doesn't pay enough and refusing to participate in that plan. Doctors can also refuse to participate in Medicare....when my parents were sick we learned very quickly to ask if a doctor accepted assignment. It was a very expensive lesson.

JanM
Apr. 7, 2012, 03:45 PM
Carol-the Medicare acceptance by doctors and group practices is a huge factor to consider when shopping for retirement locations. Higher cost areas can have huge numbers of doctors, and group practices that simply refuse to participate. When I lived in Colorado Springs (until 2003) there were lots of HMOs and other group practices that dropped Medicare participation, and I don't know if other groups still accept it or not. It can be a big problem to find Medicare providers, and I think some practices there were limiting the number of new patients they take with Medicare.

carolprudm
Apr. 7, 2012, 04:00 PM
Carol-the Medicare acceptance by doctors and group practices is a huge factor to consider when shopping for retirement locations. Higher cost areas can have huge numbers of doctors, and group practices that simply refuse to participate. When I lived in Colorado Springs (until 2003) there were lots of HMOs and other group practices that dropped Medicare participation, and I don't know if other groups still accept it or not. It can be a big problem to find Medicare providers, and I think some practices there were limiting the number of new patients they take with Medicare.

Yup

FalseImpression
Apr. 7, 2012, 09:31 PM
COL, you are in BC, right? In Ontario, I must say that waiting times for hip-knee replacement has really improved. My husband had his replacement within 6 weeks and someone else I know had his knee replacement within a month. Sometimes, you have to shop around to find a specialist with less of a waiting list too. We found a great surgeon one hour south of us and he is a great surgeon!
I still think sometimes it is being at the right place at the right time (ie my ankle surgery within 3 hours of breaking it!).
Frankly, I am very happy with the care we are getting but I still feel health care (and education) should be a federal matter,not a provincial one.

JER
Apr. 7, 2012, 09:52 PM
About all those Canadians who cross the border for the glorious health care services of the US of A:

Phantoms in the Snow: Canadians' use of health care services in the United States
(http://content.healthaffairs.org/content/21/3/19.full)

There was a nice pie chart (http://theincidentaleconomist.com/wordpress/phantoms-in-the-snow/phantoms/) that went along with it.

The US has waiting times, too. If you call a top surgeon and ask for an appointment, you'll get one in about a month, or two weeks if you're lucky. So you go see him/her, they do diagnostics, you wait for results, then you schedule surgery. They tell you their first opening is in two months.

If you want your surgery sooner, you can call a less-established practice or your 2nd-choice surgeon. In Canada, if you want it sooner, you go to an area with shorter waiting times. No real difference here.

My SO and I have US health insurance but, for most things, we like paying our own way in Canada. It's not so much that it's inexpensive (it is) but that it's very straightforward and the health care practitioner-patient relationship is more to our liking. It's much more egalitarian and far less administrative hassle.

But for the future health of the US, single payer is the only way to go. The idea that health care should be a privilege to the populace but a massive profit center for the lucky few and their hangers-on is just plain wrong.

:)

Tapperjockey
Apr. 7, 2012, 09:59 PM
I can't disagree with Mr Trump ..

Here’s what Donald Trump had to say about Obama Care.

Let me get this straight . . . …
We’re going to be “gifted” with a health care Plan we are forced to purchase and fined if we don’t,
Which purportedly covers at least ten million more people,
without adding a single new doctor,
but provides for 16,000 new IRS agents,
written by a committee whose chairman says he doesn’t understand it,
passed by a Congress that didn’t read it but exempted themselves from it,
and signed by a President who smokes,
with funding administered by a treasury chief who didn’t pay his taxes,
for which we’ll be taxed for four years before any benefits take effect,
by a government which has already bankrupted Social Security and Medicare,
all to be overseen by a surgeon general who is obese,
and financed by a country that’s broke!!!!!
What the hell could possibly go wrong?

Beentheredonethat
Apr. 7, 2012, 10:20 PM
Yeah, if Trump said it, I go with the other side. Nuff said. Classless buffoon.

Tapperjockey
Apr. 7, 2012, 10:22 PM
Yeah, if Trump said it, I go with the other side. Nuff said. Classless buffoon.

You disagree with the points he made there? I thought they were pretty good.

Beentheredonethat
Apr. 7, 2012, 10:31 PM
I pretty much disagree with everything he says. The people it's not covering now are using the ER, so it should save money. I'd like it even better if we made this single payer, or medicare for all.

This from a billionaire who declares bankruptcy and calls himself a great businessman? http://abcnews.go.com/Politics/donald-trump-filed-bankruptcy-times/story?id=13419250#.T4D4H5pSRm8

Classless buffoon. And this is the guy who still thinks the birth certificate is fake? Really?

Tapperjockey
Apr. 7, 2012, 10:49 PM
I pretty much disagree with everything he says. The people it's not covering now are using the ER, so it should save money. I'd like it even better if we made this single payer, or medicare for all.

This from a billionaire who declares bankruptcy and calls himself a great businessman? http://abcnews.go.com/Politics/donald-trump-filed-bankruptcy-times/story?id=13419250#.T4D4H5pSRm8

Classless buffoon. And this is the guy who still thinks the birth certificate is fake? Really?

I didn't say I agreed with him on everything. I just find his summary on the health care reform (obamacare) to be pretty accurate.

Foxtrot's
Apr. 8, 2012, 01:26 AM
In Canada, if we fall off a horse and get seriously injured, we are medivaced to the nearest suitable hospital, we receive all the necessary tests, treatment, post operative care and rehabilitation until we are more or less better. I hear horror stories of families going broke, communities having fundraisers, etc. for injured riders in the States. We take it for granted we will be taken care of.

Our taxes are a little higher, but we have peace of mind.

Tapperjockey
Apr. 8, 2012, 01:42 AM
In Canada, if we fall off a horse and get seriously injured, we are medivaced to the nearest suitable hospital, we receive all the necessary tests, treatment, post operative care and rehabilitation until we are more or less better. I hear horror stories of families going broke, communities having fundraisers, etc. for injured riders in the States. We take it for granted we will be taken care of.

Our taxes are a little higher, but we have peace of mind.

You also have 1/10th the population.. I wonder if that makes any difference. adjusted GDP is about the same (per person. Our GDP is about 10 x Canada's). Interestingly, the US's obesity rate is much higher (http://www.unitednorthamerica.org/simdiff.htm ) but suicide rate and doctors (per 1000) are the same. But the US has 3.9 more MRI's (per capita). LiFe expectancy rate (given that we have more alcohol use and obesity, etc) is closer than I thought it would be. We have 29% more disposable income though.. and we spend more on Social Security (type) programs and health care. As well as research, and education.

CatOnLap
Apr. 8, 2012, 01:42 AM
This is what my thread was originally started for - I am shocked that you as a doctor are also paying privately for these things.

Blugal, when I've done the math, it costs about the same for private dental insurance as it does to pay procedure by procedure, same for other health care. The insurance companies are in it to make money after all, there is no "discount" unless you belong to a very large union full of healthy young people.

Why are you shocked? Did you think that the government gave doctors a pension and health benefits? If you want those things, become a politician! :lol:

Blugal
Apr. 8, 2012, 02:39 AM
Why are you shocked? Did you think that the government gave doctors a pension and health benefits? If you want those things, become a politician! :lol:

Well frankly, yes I did think that. When you described the problem of rural versus urban, I thought, "Well, vets have the same issues, so do lawyers." But one can argue that vets and lawyers aren't essential to the same degree that doctors are. You'd think the gov'ts would actually be trying to attract and retain doctors.

In my small community, we keep getting (very good) South African doctors. Young Canadian interns come and go on their 3 or 6 month (or whatever) practicums, and the South Africans last a couple years before moving on, often to a bigger centre so they and their kids have more opportunities. We basically have a chronic shortage/turn-over - and we are in the "central interior" - not the far north.

'Round these parts, family lawyers are in scarce supply and huge demand - and all I ever hear is that the payment structure through Legal Aid is inadequate (as in, 20 years outdated, and private practice pays double). I think family lawyers are more in the "essential" category - especially when children are involved - but there was absolutely NO encouragement/incentive/carrot throughout law school or after for young lawyers to go into family law. Again, many of the factors you outlined as a doctor apply to this situation - who wants to be overworked and underpaid in a small remote community?

Blugal
Apr. 8, 2012, 02:42 AM
Blugal, when I've done the math, it costs about the same for private dental insurance as it does to pay procedure by procedure, same for other health care. The insurance companies are in it to make money after all, there is no "discount" unless you belong to a very large union full of healthy young people.

To answer this: I looked into health/dental and came to the same conclusion at least as far as procedure by procedure payments, especially for dental. However, I am signing up for short/long term disability plans through my professional association's insurance group - it is operated on a break-even basis. Don't doctors have something like that?

Coanteen
Apr. 8, 2012, 03:37 AM
Well frankly, yes I did think that. When you described the problem of rural versus urban, I thought, "Well, vets have the same issues, so do lawyers." But one can argue that vets and lawyers aren't essential to the same degree that doctors are. You'd think the gov'ts would actually be trying to attract and retain doctors.

When the government extended the single-payer system to outpatient care (it started with in-hospital care at first, and was brought in over stages), doctors opposed it because they didn't want government control. The compromise was that the government would be the "payer", ie the doctors would bill the government, not patients or private insurance, but doctors would remain independent, they would not become government employees.

Unless they're working for large companies as company docs, or for the government directly, our docs are just like US docs: private contractors, their own bosses. That includes the right to incorporate - and the necessity to budget for your own health insurance (dental, outpatient meds; the stuff our national system doesn't provide) and pension. It's private care delivery, publicly funded.

FalseImpression
Apr. 8, 2012, 01:33 PM
There are many many people in Canada who have to pay for their private insurance (not just doctors and lawyers, etc.) because their companies are not big enough to offer private insurance or because they work independently. My husband used to own a printing co. and we had good insurance through that. Then he closed it/retired and went to work for another printer who, due to financial woes, cancelled his policy to his employees. Still, all our basic needs are covered (dr visits/hospital stays, tests, surgeries, etc.). Meds are covered while in hospital. We never had dental/eye care when we did have insurance anyway. Nothing new to me.

CatOnLap
Apr. 8, 2012, 02:03 PM
To answer this: I looked into health/dental and came to the same conclusion at least as far as procedure by procedure payments, especially for dental. However, I am signing up for short/long term disability plans through my professional association's insurance group - it is operated on a break-even basis. Don't doctors have something like that?

If you join our medical association, you pay into a disability insurance plan that will cover disability for a short term-3-6 months and partial for upto 2 years. Otherwise you pay extra to have better disability coverage.

Relatively recently, the government has been funding a small portion of this disability coverage as well-and it is considered a taxable benefit, so basically, whatever the government pays in, they get back from us , almost all of it, in income taxes, but it makes for good press for them to be able to say they pay for doctors' disability. Its a farce- they pay about $400 a year to each doctor, and at the rate of a doctor's pay, they recover about $230 of it back in taxes. Mostly we pay for private coverage through OUr association dues. Most doctors, except those 2-3 % on government salary, are not eligible for Wokers' compensation. We have a higher rate of assaults and injuries in the workplace than either fireman or policemen, both groups which are covered by WCB. Neither are we eligilble for employment insurance if we should be unable to work or if our jobs end.

In terms of disability, group insurance is the best plan-either through the workplAce, a union or another association of some sort, but it does cost usually hundreds a month and it might be the same to simply bank and invest the same money.

Fred
Apr. 8, 2012, 02:12 PM
rodawn, false impression, ravenscrest-Thank you for your great posts.

Every day I thank God and Tommy Douglas (not necessarily in that order) that we have comprehensive, universal health care.

I get so angry and frustrated when I hear some Americans disparage our health care system in order to legitimize their own political views.
Nothing is perfect, but it is darn good, and as rodawn said, it is one less thing I have to worry about.

The last six months have been pretty much hell for us. We are the primary care givers for my husband's elderly, sick parents BOTH of whom have dementia.
Prior to this both of them have had a myriad of health problems and have been heavy users of our health care system.
Without our health care system, I am sure they would have lost their home, their savings, and possibly we would have lost our farm to try to pay for things.

I am so grateful we have the system we do. My father in law became very ill in November, and after numerous trips to the hospital, was finally hospitalized New Year's eve, and was there for 6 weeks.
Once his condition was stabilized he came home where he received 24/7 around the clock nursing care.
Everything necessary for him to be in his own home, from hospital bed, commode chair, pull bars, walker etc etc was provided by the gov.

We did not and have not paid one penny out of pocket.

He is now in a nursing home receiving wonderful care, and it is subsidized by the government.
My mother in law will be going into the same nursing home as soon as a room becomes available...

This has been an incredibly stressful, difficult time, but I honestly don't know how we would have been able to manage without the government organization who assisted us every step of the way, who arranged for OTs, PTs, home care aides etc etc etc....
They contacted us and consulted with us, met with us, and quite literally held our hands every single step of the way.
They treated us with professionalism and compassion,and I am eternally grateful.

To repeat:
There is NO death panel, NO ONE IN THE GOVERMENT decides what health care you will or will not get, no matter what your age.
Your health care is a matter between you and your doctor(s).

You and your MD decide, NOT a for-profit insurance company.

CatOnLap
Apr. 8, 2012, 02:30 PM
well, Fred, I am in Canada too. Here in BC, I pay privately for my mom's nursing care, and she has lost her home, and is in the process of losing her savings. She is above the savings/income limit for subsidized care. She is in no way a rich woman, but if you have any income above the OAS and CPP the government here prorates your care. $6000 a month is what comes out of her savings.

When she came out of hospital last May ( where yes, everything was paid for, but there was no OT, PTetcprovided) we paid privately for home care to come 4 times aday to help her. I slept overnight with her because at $35/hour, that is just too expensive. That was while we were on a waiting list for a government nursing home. She was still on that waiting list when it became necessary to move her to a nursing home last December. There was no way I could keepon providing the care and a place had still not come up for her ina a dementia care ward. So we were fortunately able to move into private nursing care. Which of course,means that she is no longer elegibile for the government nursing home waiting list until her savings are exhausted.

Canada is not equal. Do not think that the priveleged position that Ontario has always occupied due to its political and population domination of the rest of the country, applies to anywhere else in Canada.

And don't expect the health care system in its present form, to last more than a few years longer.

Some recent changes and those in the works? How about automatic do not resusc orders on anyone entering hopistal over age 75? How about refusing hospital admission to those over 75 with pneumonia ( the position my mother is presently in).How soon before we are 75?

Its bloody scarey.

LarkspurCO
Apr. 8, 2012, 03:00 PM
Some recent changes and those in the works? How about automatic do not resusc orders on anyone entering hopistal over age 75? How about refusing hospital admission to those over 75 with pneumonia ( the position my mother is presently in).How soon before we are 75?

Wow, is that really true? :no:

Coanteen
Apr. 8, 2012, 04:15 PM
Some recent changes and those in the works? How about automatic do not resusc orders on anyone entering hopistal over age 75? How about refusing hospital admission to those over 75 with pneumonia ( the position my mother is presently in).How soon before we are 75?

Its bloody scarey.

ORLY? Any official linkage on this, or are they just Canada's version of neocon ravings? How soon before we get our colored palm crystals?

I am also a Canadian physician, and neither I nor any of my friends have heard about these alleged recent-and-in-the-works changes.

FalseImpression
Apr. 8, 2012, 04:42 PM
I have never heard of those either or is it suggestions from BC doctors sick of the system?
Sorry you feel at a disadvantage in BC and that Ontario is privileged... but my husband's aunt suffered a stroke on Sept. 29. She was in hospital for 6 weeks, then was transferred to a chronic hospital where she still is. She has been receiving PT there every day, excellent care although she is a difficult patient. No money has come out of her or our account at all. She is now being transferred to an interim ward in the same hospital and nobody has mentioned fees to be paid. She has to choose nursing homes and will be moved to one when a room is available. There she will have to pay, but it will be subsidised (she is a Navy veteran as well).
Some days, I do think that health should be a federally regulated matter, not provincially as we have to think of getting private insurance if we go to another province. This is stupid!

And those changes ie 75 yo... come on, 75 yo are usually pretty healthy.. it is the new 50 nowadays. Did you see the reaction to increasing the age to collect OAS? I would not want to be the party introducing these changes. They would be committing political suicide...

CatOnLap
Apr. 8, 2012, 04:59 PM
Hospital policy in some places apparently, as I discovered a few years back. The new government proposals are to make them automatic DNR after 75 unless someone is advocating for you to justify the resusc. When my dad went into hospital at the age of 80, in 2008, they had an automatic DNR order on him until I came around and had it reversed with the POA I had. They made an arbitrary decision to DNR because they thought at 80, his quality of life was not that great. I would not have even known except I asked about the orders when I came to see him after he was admitted. Then 6 days later, they gave him enough morphine to knock out an elephant "for pain relief" and he died within 10 minutes of the final shot of 10 mg. They'd given him about 30 mg in the previous 12 hours. He weighed 125 lbs and had pneumonia and they gave him 30 mg of morphine, which is a respiratory depressant. The official cause of death was respiratory failure. He'd been up and talking to us earlier in the day, making total sense and not complaining of any pain. We were not expecting him to die that day when we visited earlier. They did not call a code and did not resusc him when he quit breathing after the final shot. The hospital review of his death said the morphine for pain was standard practice and that the dose was not extraordinary. You won't find this stuff on line, unless you talk to families who have been through it.

My mom is currently at the nursing home with a suspected pneumonia, and they will not take her to the hospital for an xray because techinically they say she's already in a "hospital" and there is no reason to transfer to an acute care hospital because she has dementia and is already in specialized care. Even though there is no doctor in attendance and won't be until the doc comes around on Tuesday. She is 80.

You may wish to discredit me by calling these direct personal and recent experiences " ravings" and I hope you and your relatives are never in the same position.

FalseImpression
Apr. 8, 2012, 06:05 PM
Your dad's story does ring a bell with me regarding a story done either on the Fifth Estate or W5 and Sunnybrook Hospital in Toronto regarding a similar story. The daughter in that case was a nurse and she sued the hospital for similar reasons. Morphine was given and he died.

I do not believe they would not have taken my husband's aunt back to the hospital if she had had another stroke because it was discussed. She is 89. I know of other cases where residents of nursing homes were taken to hospital for pneumonia or other ailments.

IOW, it is doctors deciding to save a few bucks vs lives. Nice to see how they respect the oath they took which never discriminated due to age!

Coanteen
Apr. 8, 2012, 09:45 PM
The new government proposals are to make them automatic DNR after 75 unless someone is advocating for you to justify the resusc. ...

You may wish to discredit me by calling these direct personal and recent experiences " ravings" and I hope you and your relatives are never in the same position.

If there are official government proposals, then yes, they will be online (or somewhere official they can be linked to), and it is perfectly fine to call it "ravings" if someone claims the government wants to make this aCanadian health care standard but can't provide any proof. Because they are ravings.

As for your parents - yes, I've seen cases like that. Often it's the nursing home that refuses to transfer, rather than a hospital refusal to accept. I've also seen ICU docs refuse admission to repeat patients, but very rarely. Like that poor demented lady who kept having to be intubated because her family kept taking her home to "care" for her and fed her solids against advice and she kept aspirating. Finally the ICU doc refused to admit, so nobody would intubate her, and the poor soul was allowed to die.

But see - I'm now finishing 2 years in the US. I hear the exact same stories here, again often the nursing home refusing to transfer to an acute hospital. It has nothing to do with the Canadian national system, nor is it new enough to be Obamacare-related. It is not some kind of "kill the elders" official policy, under either system.

I've also witnessed and heard about cases of the opposite - where there is an advanced directive, but the medical system ignores it and resuscitates/continues to treat the patient. This more in the US than in Canada, but it too happens in both countries.
It probably happens everywhere, under any medial system, both scenarios. Heck, refusal to transfer happened to my grandma back in the Old Country. That doesn't make your ravings about some mythical official upcoming Canadian health system rules for over-75's any less ravey, because that's just what they are. Ravings.

Fred
Apr. 8, 2012, 10:07 PM
If there are official government proposals, then yes, they will be online (or somewhere official they can be linked to), and it is perfectly fine to call it "ravings" if someone claims the government wants to make this aCanadian health care standard but can't provide any proof. Because they are ravings.

As for your parents - yes, I've seen cases like that. Often it's the nursing home that refuses to transfer, rather than a hospital refusal to accept. I've also seen ICU docs refuse admission to repeat patients, but very rarely. Like that poor demented lady who kept having to be intubated because her family kept taking her home to "care" for her and fed her solids against advice and she kept aspirating. Finally the ICU doc refused to admit, so nobody would intubate her, and the poor soul was allowed to die.

But see - I'm now finishing 2 years in the US. I hear the exact same stories here, again often the nursing home refusing to transfer to an acute hospital. It has nothing to do with the Canadian national system, nor is it new enough to be Obamacare-related. It is not some kind of "kill the elders" official policy, under either system.

I've also witnessed and heard about cases of the opposite - where there is an advanced directive, but the medical system ignores it and resuscitates/continues to treat the patient. This more in the US than in Canada, but it too happens in both countries.
It probably happens everywhere, under any medial system, both scenarios. Heck, refusal to transfer happened to my grandma back in the Old Country. That doesn't make your ravings about some mythical official upcoming Canadian health system rules for over-75's any less ravey, because that's just what they are. Ravings.

You said it better than I could Coanteen.

DNR anyone over 75?
Sounds like fire and brimstone to me. :no:

texan
Apr. 8, 2012, 10:29 PM
Hospital policy in some places apparently, as I discovered a few years back. The new government proposals are to make them automatic DNR after 75 unless someone is advocating for you to justify the resusc. When my dad went into hospital at the age of 80, in 2008, they had an automatic DNR order on him until I came around and had it reversed with the POA I had. They made an arbitrary decision to DNR because they thought at 80, his quality of life was not that great. I would not have even known except I asked about the orders when I came to see him after he was admitted. Then 6 days later, they gave him enough morphine to knock out an elephant "for pain relief" and he died within 10 minutes of the final shot of 10 mg. They'd given him about 30 mg in the previous 12 hours. He weighed 125 lbs and had pneumonia and they gave him 30 mg of morphine, which is a respiratory depressant. The official cause of death was respiratory failure. He'd been up and talking to us earlier in the day, making total sense and not complaining of any pain. We were not expecting him to die that day when we visited earlier. They did not call a code and did not resusc him when he quit breathing after the final shot. The hospital review of his death said the morphine for pain was standard practice and that the dose was not extraordinary. You won't find this stuff on line, unless you talk to families who have been through it.

My mom is currently at the nursing home with a suspected pneumonia, and they will not take her to the hospital for an xray because techinically they say she's already in a "hospital" and there is no reason to transfer to an acute care hospital because she has dementia and is already in specialized care. Even though there is no doctor in attendance and won't be until the doc comes around on Tuesday. She is 80.

You may wish to discredit me by calling these direct personal and recent experiences " ravings" and I hope you and your relatives are never in the same position.

If this did happen, than i would be seriously having a chat with the doctor. I have been through four deaths, and NEVER was this done. It was a question that had to be completed on the paperwork when you are admited to the hospital. In the case were the patient is not able to advocate for themselves, the next of kin does. Heck, it was just on W5 or a program like that about assisted suicides. There was plenty of older people on the program wanting to choose their way to die. Many of them were over 75.
Like someone else said, where is the documentation of this becoming a law.?
While i understand that each province has their own health care, I to am extremely happy to pay my taxes and have my health care. My husband was sick for 20 years, and never once did I have to pay anything, right up to the day he died. Actually, i just wanted to say how happy I am to live in Canada, in all aspects not just health care. We are very lucky.

Moogles
Apr. 9, 2012, 12:21 AM
First of all I am very sorry to anyone who has lost a loved one unexpectedly or felt they were not care for properly. I can assure you that Canadian doctors and the healthcare system are not out to kill older people to save a few bucks. In my experience, often far more care is given than needed. For example, I have had to personally disconnect TPN (nutrition via IV) on a deceased patient that had been unresponsive for 2 days. This was completely unnecessary as the pt was expected to die, however the family was very distraught that we were "starving" the patient. The pt required a $600 special IV line and the TPN itself is hundreds of dollars a bag. This was a significant cost to the healthcare system, however it was done because the family was insistent. This cost was of greater benefit to the family's mind than to the patient.

Look at this scenario from another angle. COTHer comes on the board saying "those darn nurses and doctors are starving my family member only because they think he is going to die". Obviously not the case, but that is how they interpret it. This stems from lack of understanding. There are certain treatments that will have no bearing on outcome, or provide comfort for that matter, to the patient. This is why people are specialized to provide medical care.

Now on the the DNR status. Yes doctors will make someone a DNR status if no family is present to discuss status with. Do you know why?

It is because they try to look at the whole picture. What is the level of functioning of the pt, their quality of life, if treatment were provided would they recover or would it be futile? If treatment, including resuscitation, were provided what would the chance of this patient having a meaningful recovery? Will they ever be able to speak, provide self care, even breath on their own?

If a team of intensive care doctors, ward doctors, and other specialists come to a decision that resuscitation will be of no benefit, then yes someone will be made a DNR. Sometimes this will be against family wishes, but only because those wishes are either ill informed or unreasonable.

Yes I said unreasonable. Do you know how many people want a demented 90 year old who can't feed them self, recognize anyone and bed bound "fully resuscitated" and kept on ventilation when that person aspirates and develops a pneumonia? It is unfortunately all too common. What benefit is it to the patient to be stuck on a respirator in ICU and unable to be extubated? How much harder is it on the family to decide that they now have to withdraw care after months of no improvement?

In some of these cases I fully agree that comfort care would be more beneficial to the patient than resuscitation.

Now to the lady whose father died who had pneumonia. Is it plausible that the cause of death, respiratory failure, was in fact due to the pneumonia itself? Often opiates, like morphine, can be given to reduce dyspnea (difficulty breathing) in a pt with respiratory problems. Or possibly, your father had pain and they were attempting to make him more comfortable. I am obviously only speculating, but just want to add another view point. Again, I am terribly sorry for your loss.

Spooks
Apr. 9, 2012, 10:51 AM
I am a dual citizen, and have lived in both countries. I much prefer the Canadian system. The main problem we are having in Quebec is a shortage of family doctors - it is extremely difficult to get one. There are several causes of the shortage, and new doctors coming here have to be proficient in French so that limits the pool quite a bit. That said, I have had zero problems getting treated, or seeing a specialist. It was quite a shock the first few times I went to a doctor and did not have to fill out a ream of paperwork, and then deal with confusing co-pays, deductibles, and statements for months afterwards, of have to consult the manual to find out what was covered and not covered. Plus, there is no such thing as a pre-existing condition here. I will never forget my US friend telling me that she was denied health insurance because she had had uterine fibroids in the past...which led her to have a hysterectomy...hence eliminating the possibility of ever having this condition again.

One thing many people do not think of is the freedom we have in Canada to be self-employed or run a small business without having to face the crippling cost of private health insurance. I am a contractor, and I would never have taken the step to cut the full-employment apron strings had it not been for universal health care. If I were still in the US I would not have made this career choice.