health insurance bill

[mjarrels]

Scary thing is that this bill was wrote by staffers... No elected officals wrote this 2000 plus bill. Saw some thing the other day that many staffers earn more money than the elected officals do. My clerk of the court (120.000 income) is a prior district 6 congressman staffer who will probably be feed of the public for his entire life.

mark

 

[LostInTheWoods]

OHIP is fairly straightfoward. You go to a health care provider (doctor, hospital, E.R.), they bill OHIP directly. OHIP pays the bill. You don't have to be pre-approved for procedures that your doctor GP/specialist asks for. In that sense, it is not bureaucratic. I frankly don't know what the experience is at the doctor's end. The bureaucracy might well show up at their end of the experience.

I like simplicity for the consumer. Go in, get your service, go home. A certain amount of bureaucracy on the provider's end is acceptable. So long as it is not too cumbersome.

OHIP openly lists what is covered and what is not. You are free to purchase additional insurance for things above the basic healthcare that OHIP provides, or pay for it e.g. no chiropractic care is provided, if you are hospitalized, basic OHIP care is for a ward room that you share etc. etc. OHIP sets rates of remuneration for procedures and visits

This would boil down to just how "basic" the basic healthcare is. If it covers the vast majority of what is commonly needed in delivering quality healthcare, then I would argue its acceptable.

Typically, most insurance here will net you a roomie during hospital stays, unless ,as examples, you have a highly communicable disease, or are there for labor and delivery. I think this is perfectly acceptable.

I am assuming there's no outcry from physicians about the rates of remuneration. So far, so good.

On balance, our doctors make a lot less money than your doctors. A good friend of mine is an accountant. He has about 10 GPs that are his clients. He says on average they make $300000 per year. Specialists make $800000 to $1000000 a year. Based on these figures, I would say they are not underpaid.

I'm not sure what the exchange rates are these days, but the numbers you're quoting are way more than average physician pay here. To the tune of 30-50%. If these numbers are acorrect, you may have to teach me how to sing O Canada!

Unless the cost of living is dramatically higher in Canada, I don't know how those numbers could be accurate.

Yes there are wait times for things. My wife just had an MRI done on her knee. It was three weeks after the doctor asked for it. It was not an emergency. I don't consider it unreasonable.

Nor would I, for the majority of cases. While true, if you need an MRI in my area, I could probably get you seen for a non-emergent one within 72 hours (and an emergent one instantly). What if your injury were severe enough to keep you on crutches and prevent you from working on an assembly line, but not urgent enough to avoid the three week wait?

On the plus side, basic coverage exists for everyone. If you need heart surgery, you get it. If you want a tummy tuck - then its on your tab .

Good luck finding an insurance plan here that covers cosmetic surgery. Unless, that is, it is required to restore function after burns/trauma/etc. Would the Canadian system provide cosmetic surgery in cases like this, or would that exceed "basic" care?

On balance, I would say it is a relatively decent system that does need improvements. I would like to see an approach that is more customer oriented. I don't like the fact that the nurse staff are unionized and thus the best ones get pay raises equal to the worst. I'd like to see more private delivery of health care through the public system i.e. more for-profit hospitals, MRI clincs etc. There is nothing that prevents this as X Ray, Ultra sound clinics are privately run but the bill is sent to OHIP and OHIP pays for them so long as your doctor asked for the procedure. I'd like to see hospitals compete with each other and I believe that they will do this best if they are for profit institutions. The funding rates can continue to be set by OHIP. Procedures can still be paid for by the public insurance plan.

I'm not sure what you mean by "customer oriented". Are you saying that when being treated you essentially feel like "just another number"?

As far as unions, well, it's a lot like healthcare, there's good and bad. Part of the bad is, yes, you see the bad rewarded with the good. I don't think I can go down that path without grossly violating the site's rules, so, let's just say I know what you're saying.

 

[turbo36]

canoetrpr, lostinthewoods, Just want to say I'm really enjoying the discussions going on here, a very refreshing change from the normal name calling and "out-rage" statements. :thumbsup:

 

[2manyrocks]

The problem with leaving any loophole for the insurer is that it being a private enterprise whose goal is to make a profit, will do its best to find a way to get out of paying for eventual health problems that may even be remotely related to whatever the pre-existing condition / past drug use / moral hazard was. The insurance companies are not daemons. They are simply businesses and do what businesses do best and try to make a the most for their shareholders.

Just my $0.02 CND (and it is worth quite a bit these days!)

So what happens under the bill to treatments that were considered "experimental" and not usual, customary and reasonable under most insurance plans? If they have to cover all prexisting conditions, what treatment do they have to provide?

 

[canoetrpr]

So what happens under the bill to treatments that were considered "experimental" and not usual, customary and reasonable under most insurance plans? If they have to cover all prexisting conditions, what treatment do they have to provide?

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

I think that the business of what happens with such treatments is orthogonal to your present legislation for the most part. Although it might expedite the eventuality of 'rationing' and generate the reasonable debate that needs to be had. Reality is that we will not all be able to be kept alive no matter what the cost. Problem is that when we are individually affected, or our loved ones are, we will want every treatment that is available. It is a very difficult discussion.

 

[LostInTheWoods]

canoetrpr, lostinthewoods, Just want to say I'm really enjoying the discussions going on here, a very refreshing change from the normal name calling and "out-rage" statements. :thumbsup:

Name-calling and demagoguery have been all too evident in politics. For my entire adult life, I have seen it displayed from all angles. To a point, it is understandable. Often, its just a visceral response to something that doesn't feel right. And when you see your elected officials involved in scandal after scandal, repetitively engaging in the egregious mishandling of other people's money...well, I can see where they're coming from.

Take this guy, for example: FOXNews.com - Teacher Who Sought to 'Demolish' Tea Party Placed on Leave From School

I think I covered this before. You can't argue your point logically? Try villainizing.

But how does this really help your country, and by extension, yourself?

I've learned many lessons in life. One of the hardest lessons to learn is to not cut off your nose to spite your face. What if what the other guy is proposing really is better? There are a few areas where there's really no room to compromise. Abortion, for example (And no, I'm not arguing for or against abortion. And no, I don't want to discuss abortion in any detail).

But healthcare is not one of those areas.

 

[LostInTheWoods]

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

Um, just how many months or years does one need to be prepared to forgo for the "greater good"?

Is this situational?

"Mrs. Johnson, you're 83 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

Vs.

"Mrs. Johnson, you're 38 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

 

[canoetrpr]

I'm not sure what the exchange rates are these days, but the numbers you're quoting are way more than average physician pay here. To the tune of 30-50%. If these numbers are acorrect, you may have to teach me how to sing O Canada!

Unless the cost of living is dramatically higher in Canada, I don't know how those numbers could be accurate.

Hmm. I was quite sure those numbers were correct. I'm meeting with my accountant buddy this week so I will double check with him. To be honest I am quite surprised if the average physician makes less than this in the USA.

What if your injury were severe enough to keep you on crutches and prevent you from working on an assembly line, but not urgent enough to avoid the three week wait?

I think things get murky here and I believe that these are the kind of reasons why people believe it is unacceptable to have as long as a 3 week wait. That said, most employers will accommodate you through some sort of a short term disability plan. If you are a tradesperson, or a contractor working on your own, a 3 week wait would be terribly hard on you. Here I'd be inclined to pay the cash and get an MRI done outside the system - which can be had.

Good luck finding an insurance plan here that covers cosmetic surgery. Unless, that is, it is required to restore function after burns/trauma/etc. Would the Canadian system provide cosmetic surgery in cases like this, or would that exceed "basic" care?

Yes the system would cover cosmetic surgery in cases like this.

I'm not sure what you mean by "customer oriented". Are you saying that when being treated you essentially feel like "just another number"?.

Yes there are times where you feel like a bit of a number. Depends a lot on your provider of healthcare. Not always. This is a bit union related as well and perhaps I am mixing my perception up a bit based on that. I would like patients to be asked to evaluate the care that they receive from their nurses, and for the nurses to be remunerated based on those patient evaluations. The nurse's union isn't going to be doing that. As a result in my hospital stay, I found a range of nurses. Some were simply fantastic. Others were terrible.

We have a big debate here on whether providers of healthcare (like hospitals and MRI clincs, basic outpatient procedures) should be allowed to be for profit. It is a no brainer to me. The public insurance plan should not care about how the services are delivered. They should have the freedom to set the rates and if a private clinic can provide it with the appropriate quality of care, then they should be allowed to do so and the patient should decide where they want to go for their treatment.

The counterpoint that the 'socialists' use to allowing 'for-profit' surgery clincs etc. is they will tend to suck the most profitable parts of a publicly run hospital's business (e.g. basic outpatient procedures like knee replacement, etc .etc.) and the complex and non-profitable stuff will be left with the publicly / not for profit run hospitals.

I also support a two tier system where people can pay more to avoid longer wait times for non emergency procedures. This is also not supported by the majority of the population here I believe. They have a valid point of view - I'm not debating that they don't. The biggest fear about allowing this is that it is a slippery slope which will result in the so called 'rich' to get better care then 'the rest of us'. The reality is that we already have a two tier system. The USA (and India and other countries who allow these services to be offered for profit) are already our second tier. If you need a procedure done pronto, and the wait list to get it done is too long for you, you can get it done in the USA or India - and some people do. The expenses to do this sort of thing are very high and so it is only the very well off that can afford it.

I don't get too upset as a result if some politician or someone else went to the USA for a procedure. They decided that they needed it badly enough, quicker than the public system could provide and they were willing to pay for it. That does not mean that the public system does not work for most of us. There are of course areas from time to time where the wait list might be ridiculous for the procedure and if it is not fixed in a reasonable amount of time, governments get voted out.

 

[LostInTheWoods]

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

Another problem with that is that the wealthy...say, oh, I don't know, your average politician...aren't much worried by that little caveat, are they? Things get bad, we'll just go wherever we need to and pay cash.

 

[canoetrpr]

Um, just how many months or years does one need to be prepared to forgo for the "greater good"?

Is this situational?

"Mrs. Johnson, you're 83 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

Vs.

"Mrs. Johnson, you're 38 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

To be honest I don't know the exact details on the cases I was telling you about. That said I think these are exactly the difficult conversations that we are all going to have to be willing to have.

I don't think this is only related to a publicly funded system. The availability of new health procedures and drugs is going to get us to a point such that if you would want to have access to every single procedure out there, no matter the cost or the probability of success, you would have to pay your whole income and perhaps more to be able to afford insurance that could provide it.

All systems are going to have to set a 'reasonable' bar as to what treatments they will pay for and what they will not pay for. What is considered 'reasonable' is well.... a tough call. Suffice it to say that if a pill costs a billion dollars a month and will extend your lifespan from 'you've got six months to live' to you can live to 85, no healthcare system could afford that. The entire economy would just be healthcare otherwise.