Is Canadian health care all it is cracked up to be

[southsider2k5]

Call me bored today...

 

Steve Chapman

Is Canadian health care a contradiction in terms?

 

 

To critics of the American health-care system, Shangri-La is not a fantasy but a shimmering reality, though it goes by another name: Canada. Any debate on health care eventually arrives at the point at which one participant says, "We should have what Canadians have. Free care, universal access and low cost--who could ask for more?"

 

Well, plenty of people could ask for more--starting with the Supreme Court of Canada. Last week, ruling on a challenge to the health care in the province of Quebec, the court sent a clear message south: Don't believe the hype.

 

The program, said the court, has such serious flaws that it is violating constitutional rights and must be fundamentally changed. And the flaws, far from being unique to Quebec, are part of the basic structure of Canada's health-care policy.

 

No one doubts that the American model has serious defects, particularly rising costs and lack of access to medical insurance. But anyone who thinks the Canadians have come up with a magical solution is doomed to disappointment.

 

The dirty secret of the system is that universal access is no guarantee of treatment. Sick Canadians spend months and even years on waiting lists for surgery and other procedures. In 1993, the average wait to see a specialist after getting a doctor's referral was nine weeks. Since then, according to the Fraser Institute of Vancouver, it has increased to 18 weeks.

 

The typical patient needing orthopedic surgery has time to get pregnant and deliver a baby before being called. The Supreme Court cited the testimony of one orthopedic surgeon that 95 percent of patients in Canada waited over a year for knee replacements--with many of them in limbo for two years.

 

In some cases, the delay lasts longer than the person enduring it. Or as the Supreme Court put it: "Patients die as a result of waiting lists for public health care."

 

Not only does the government subject its citizens to painful and even fatal delays in the public system, it bars them from seeking alternatives in the private market. You see, it's illegal for private insurers to pay for services covered by the public system.

 

That policy is what forced the Supreme Court to order changes. "The prohibition on obtaining private health insurance," it declared, "is not constitutional where the public system fails to deliver reasonable services."

 

The program has created a gap between supply and demand that is wider than Hudson Bay. Its failings, however, go beyond that. The single-payer approach, for example, is often held up as the only way to simultaneously control costs and deliver quality care. In fact, Canada has somehow managed to do neither.

 

After adjusting for the age of the population, the Fraser Institute compared 27 countries in the Organization for Economic Cooperation and Development that guarantee universal access to health care. By some mysterious alchemy, Canada has proportionately fewer physicians than most of these nations but spends more on health care than any except Iceland.

 

It would be a dubious feat to control costs only by depriving people of treatment. But to forcibly deprive people of treatment while letting costs surge is no achievement at all.

 

Admirers of our good neighbor to the north say the United States pours money into all sorts of fancy equipment but doesn't get better results by such measures as life expectancy. But life expectancy is affected by multiple factors, including education, crime rates and diet--with health care playing only a modest role. In those areas where modern medicine can make a big difference, the United States does very well.

 

Take breast cancer. In Britain, which is famous for its socialized system, close to half of all victims die of the disease, according to a recent Cato Institute study by John Goodman, head of the National Center for Policy Analysis. In Germany and France, almost one-third do. In Canada, the figure is 28 percent--and here, it's 25 percent. Our mortality rate for prostate cancer is 67 percent lower than Britain's and 24 percent lower than Canada's.

 

The usual story we hear is that the health-care system next door provides first-rate care to all, at low cost. The realities--dangerous delays, bloated expenditures and mediocre results--are not so appealing. American liberals may not welcome evidence that the single-payer model works far better in theory than in practice. But for that, they can blame Canada.

[KipWellsFan]

I just hope in Moore's next movie about health care he doesn't use Canada's system as something the US can strive for.

 

but that article seems to make it seem that Canada's system is worse than America's, here I don't think I agree.

 

http://www.signonsandiego.com/uniontrib/20...1e28gerber.html

These savings are largely responsible for health care costs totaling 9.6 percent of Canada's GDP, compared to 14 percent of GDP in the United States, where administrative costs of private insurance plans may range as high as 35 percent.

Edited June 17, 2005 by KipWellsFan

[YASNY]

I just hope in Moore's next movie about health care he doesn't use Canada's system as something the US can strive for.

 

but that article seems to make it seem that Canada's system is worse than America's, here I don't think I agree.

 

http://www.signonsandiego.com/uniontrib/20...1e28gerber.html

 

This isn't worse?

 

The dirty secret of the system is that universal access is no guarantee of treatment. Sick Canadians spend months and even years on waiting lists for surgery and other procedures. In 1993, the average wait to see a specialist after getting a doctor's referral was nine weeks. Since then, according to the Fraser Institute of Vancouver, it has increased to 18 weeks.

 

The typical patient needing orthopedic surgery has time to get pregnant and deliver a baby before being called. The Supreme Court cited the testimony of one orthopedic surgeon that 95 percent of patients in Canada waited over a year for knee replacements--with many of them in limbo for two years.

 

In some cases, the delay lasts longer than the person enduring it. Or as the Supreme Court put it: "Patients die as a result of waiting lists for public health care."

[Texsox]

And proponents of keeping our system should remind us there is no way we could do this better than the Canadians. Name one thing we have done better than the Canadians

[EvilMonkey]

I wouldn't trust it merely because it would be run by the government. The waste and fraud would rival that is any current federal moneypit, probably topping the next 2 or 3 combined. It's bad enough they run my retirement, try to run my business and keep trying to intrude into my life, get out of my doctors office.

[Texsox]

I wouldn't trust it merely because it would be run by the government.  The waste and fraud would rival that is any current federal moneypit, probably topping the next 2 or 3 combined.  It's bad enough they run my retirement, try to run my business and keep trying to intrude into my life, get out of my doctors office.

 

Are you saying our government isn't any good? That Americans cannot govern and run a program?

[knightni]

And proponents of keeping our system should remind us there is no way we could do this better than the Canadians. Name one thing we have done better than the Canadians

Slam Dunk?

[EvilMonkey]

Are you saying our government isn't any good? That Americans cannot govern and run a program?

I am saying that whenever a program is taken over by the government, it grows exponentially because there are crooks on all sides that want to get their 'piece of the pie', paperwork will increase and productivity will go down.

[Balta1701]

Left-leaning blogger Ezra Klein did a series he called "Health of Nations" a few weeks ago. Here is his bit on Canada's health care system.

 

The Health of Nations: Oh, Canada!

 

Next on our tour of health care systems would have to come Canada. I've been debating whether or not to do them because their setup is so well-known, on the other hand, it's also something of an anomaly that's often romanticized to a degree it shouldn't be, so it seems worth the effort. If you're new to the series, you can find France here and England here. Off we go.

 

Da Basics: Canada care is unapologetic, no-holds-barred single-payer. The single-payer, by the way, is not Canada as a whole, but each specific province, so it's not quite as monolithic as we think. It's financed by taxes, but the taxes vary from province to province, so there is a certain amount of variation in how the system pays its bills. But I'm going to stay away from that -- keeping you guys still for health policy is dicey enough, if I start throwing in tax policy, my blog will have tumbleweeds blowing through it (and maybe a shoot-out in the saloon, but that's another story).

 

Like England, Canada's insurance has nothing to do with occupation, age, citizenship, or any other variable. If you're on the grounds of our Northern neighbor, you're covered. The system covers everything, though drug benefits and long-term care vary a bit across provinces. What's interesting about Canada's incarnation of single-payer, though, is how pure it's kept. France and England, as we saw, both have a significant role for supplementary insurance beyond the government's basic offering. Not so in Canada, where add-on insurance isn't even allowed. That makes for a remarkably level playing field. Care varies only according to province (and, assumedly, individual doctors and hospitals), not according to class. Interestingly, low-income Canadians actually receive more care than do the affluent, owing to the higher rates of disease in poorer communities.

 

To be clear, there is a little bit of supplementary insurance floating around, but it can only be used for certain amenities, like private rooms. Hospitals are simply not allowed to bill private insurers for services covered by the provincial plans. So say nighty-night to the private sector.

 

Canada is a gatekeeper system, and 55% of their doctors are general practitioners playing that role. Specialists can see patients without a GP referral, but they don't receive the highest compensation from the government and so most won't do it. As that alludes to, Canada's doctors are paid on a fee-for-service basis, so there's no incentive (a la Britain) to withhold treatment. Hospitals, on the other hand, negotiate a global budget with provincial government, which is to say they get a lump sum rather than a fee-for-service. That makes adapting to changing circumstances or varying needs harder than it'd otherwise be, as the money is allocated from the start, rather than in response to circumstances.

 

Cost: In 1970, the year before Canada's health care system came online, Canada and the US spent about the same on health care, 7.2% and 7.4% of GDP respectively. By 1990, it was 9% and 11.9%. And by 2002, it was 9.6% and 14.6%. So while our health care spending shot up by 7.6% of GDP and still doesn't cover out citizenry, theirs had a 4.5% climb and got everyone in the goddamn country covered (remember: the first number is pre-universal health insurance). During the 90's, Canada's health care costs (as a % of GDP) actually dropped. Dropped! And these differences aren't a result of fewer services rendered. Indeed, Canadians, on average, spend more days in the hospital and have more visits with their physicians than Americans do. The lower costs are accounted for by three things:

 

1) Lower administrative costs. This one will blow some minds. Despite being a bureaucratic leviathan or whatever, America's administrative costs are 300% greater per capita than Canada's. So much for the vaunted efficiency of the private market.

 

2) When Canadians do spend a day in the hospital, it's much cheaper. Costs per patient per day are quite a bit higher on our side of the border.

 

3) Physician's fees and pharmaceutical prices, which are way higher on this side of the border.

 

The fiscal austerity of the 90's, which helped drop costs of the program, did make for a worse health care system, or at least one that netted less satisfaction. Wait times for elective surgeries increased, though it should be noted that Canadians wait, on average, less time for vital operations such as transplants. Oh, and the "hordes of Canadians rushing across the border for care thing"? Mostly myth.

 

The only verified cases are a) folks in the US on vacation or B) folks who don't want to wait for an elective procedure and can pay to do it out of pocket. Think about that for a second -- the primary criticism of the Canadian system is the "wait times/they come here" combo, but what's really going on is a prioritization of procedures and a few rich folks deciding not stand in line. So in Canada, it's the rich who can't get the care they want, but everybody can get the care they need. Here, the rich can get all the care they want, and many of our poor and lower-middle class can't simply wait in line for elective procedures -- they simply can't get them. It's all about priorities.

 

Recently, the Canadian government, In response to the drop in citizen satisfaction, substantially increased the program's funding (by $33 billion, I think) and began some restructuring. The effects of those changes aren't in yet, as they were just passed in 2003.

 

How Do We Stack Up? In simple ratings, Canada is 30th while we're 37th (according to the OECD). So they're a bit better, but it's not like the giant disparity we had with France, whose system takes the coveted top slot. As noted above, the Canadian system is significantly cheaper as a percentage of GDP than is the American system, despite the fact that the former covers everyone and the latter leaves a fair chunk of its population out in the cold. On the years of life lost metric, American women lose 3,836 years per 100,000 women and the men give up 6,648. The comparable Canadian figures are 2,768 and 4,698 respectively.

 

Canada's health care system, much more so than the others we've looked at, is a pure single-payer effort. It's really run by the government, private insurance is barred from interfering in any significant way, and so on. And despite the vaunted inefficiencies of government, they manage to cover their entire population with administration costs that're 300% less than ours per capita. Considering that 42 million of our folks aren't even in the system, the difference is even greater than that. Much of it comes from the simplicity of having the government pick up the tab rather than forcing doctors to haggle with insurers, but not all. In any case, that metric blows my mind.

 

In any case, Canada's got some problems. Wait times for elective surgeries can suck real bad and, according to an LA Times article from April 10th, some folks do cross the border to speed things up. But vital procedures are done quicker and, amazingly, any Canadian can get any necessary surgery done that they want. If elective, it may take some time, but there's never a question over whether they'll be treated. So next time someone goes off on Canadians-in-line to you, remember: the question they're facing is whether to allow the rich to pole vault over the poor. America looked at that calculus and chose the rich; our poor don't have mere waiting times to face, many of them simply can't get any non-emergency medical care. That doesn't happen in Canada, and it doesn't happen because their system is aimed at never letting it happen. Frankly, if our uninsured knew they could do it, it'd make much more sense for to flee to Canada for treatment than it does for the Canadian rich to cut their wait times by paying out-of-pocket here.

 

Sources: LA Times articles from Lexis-Nexis, Thomas Bodenheimer's Understanding Health Policy, OECD data sets, Matthew Holt.

[Texsox]

I am saying that whenever a program is taken over by the government, it grows exponentially because there are crooks on all sides that want to get their 'piece of the pie', paperwork will increase and productivity will go down.

 

So if I understand your statements, we could not run the program any better than Canada? Paperwork may go up, but with only one payer (us), versus hundreds of payers (insurance companies) it may be easier to follow and ultimately go down. I don't think we'd hire all new Doctors, Nurses, hospital administrators, etc.

 

The whole "our government is incompetent" thinking is one of the bad cards the GOP picked up. How they can continue to make statements that basically say we suck at running things, and get elected, just boggles my mind. Yet if Kip made that statement, we would be jumping down his throat faster than one of those lumberjacks in that thing they, and ESPN, call a sport.

 

One area I would like to see some improvement in our health care system is to help small business compete for the better employees. Business owners like Evil are not going to outsource to Malasia. They are going to hire locally and keep the jobs locally. However, they are also at a huge disadvantage in health insurance rates. Small groups are almost impossible to insure and the premiums are usually high. One way to help small business' grow, is in health care.

 

It is also tough in some industries like mine that employ people at the lower end of the pay scale. I was looking at one plan for my emplyees and it was costing almost $600/month per employee for single coverage. That is $3.75 per hour added to a $7.25 per hour employee.

[EvilMonkey]

So if I understand your statements, we could not run the program any better than Canada?

 

 

Sure, we could probably run it 'better', but it would still probably suck.

 

The whole "our government is incompetent" thinking is one of the bad cards the GOP picked up. How they can continue to make statements that basically say we suck at running things, and get elected, just boggles my mind.

Maybe the same way the liberals can keep saying they support the troops then turn around anc call the Commander in Chief a Nazi or a liar. Can you think of a well run government program? I'm sure there are, but they are probably pretty small. Social Security is a f***ing joke, with the mismanagement, waste and fraud that goes on there. Medicade is screwed up, with doctors taking advantage of poor management and double billing, ghost billing, etc. Every year, a report comes out from the GAO that there is money out there that the government just can't account for. Can the government do somethign right? I sure hope so. But I don't want to find out with health care.

[Texsox]

Sure, we could probably run it 'better', but it would still probably suck.

Maybe the same way the liberals can keep saying they support the troops then turn around anc call the Commander in Chief a Nazi or a liar.  Can you think of a well run government program?  I'm sure there are, but they are probably pretty small. Social Security is a f***ing joke, with the mismanagement, waste and fraud that goes on there.  Medicade is screwed up, with doctors taking advantage of poor management and double billing, ghost billing, etc.  Every year, a report comes out from the GAO that there is money out there that the government just can't account for.  Can the government do somethign right?  I sure hope so.  But I don't want to find out with health care.

If KipWellsFan or another foreign based poster made the above statement, we would run his ass off the board.

Fraud in government programs are almost always the result of recipients, not the employees that work there. Compare it to Tyco, Enron, and others, our government seems a whole lot more honest than the private sector. There isn't an organization, public or private, on this planet anywhere near the size of the federal government that can account for 100% of their expenditures. And it probably isn't worth the time to try. Is it worth an hour of your time to find a missing $2.00 receipt for your business? Worth hiring an employee at $10 per hour to spend 40 hours tracking a $200 per week expense? That would be waste.

 

The fact that we have caught dishonest Doctors shows that the system is working. Those same Doctors also try and deceive the private insurance companies as well. People rob banks, are the banks mismanaged? Showing they are victims of crimes does not make them poorly managed.

 

Social Security is in trouble because we have bought into a belief that we can somehow have things without paying for them. If we cut taxes enough, we will then collect more money to pay for this stuff. Waste is such a small drop compared to offering more in benefits than what has been paid in.

 

Eradicating Polio was a government program. The TVA was a government program. Our environment is much cleaner because of government programs. We are slowly becoming more fuel efficient, again government programs. Our military is pretty damn good. Our USPS is amazing. $0.37 for a letter from Los Fresnos Texas to Moosejaw, Maine and you know it will get there in under a week.

 

But hey, I love my country and think Americans can do anything. I guess that's the problem with being a liberal. I'm too enthusiastic about Americans.

[southsider2k5]

Are you saying our government isn't any good? That Americans cannot govern and run a program?

 

Government run programs by their very nature inspire waste and ineffeincy. There is ZERO incentive to keep costs down, and service up, like there is in the private sector. As an economist, I would argue that the downfall of US medicine is already having too much government influence and a lack of competetion created out of excess lawsuits. Plus when you factor in the subsidies paid in the form of insurance and government aid, you have all of the artificial price increases, plus a monopolistic pricing structure.

 

All of these things would only get worse with the government being the only choice.

[Texsox]

Government run programs by their very nature inspire waste and ineffeincy.  There is ZERO incentive to keep costs down, and service up, like there is in the private sector.  As an economist, I would argue that the downfall of US medicine is already having too much government influence and a lack of competetion created out of excess lawsuits.  Plus when you factor in the subsidies paid in the form of insurance and government aid, you have all of the artificial price increases, plus a monopolistic pricing structure.

 

All of these things would only get worse with the government being the only choice.

 

I disagree that waste and inefficiencies are unique or even more so in government programs. Listen to posters here rant about their employers. Look at the front page of executives going to jail and paying record fines. Look at the lawsuits against HMOs, private insurance companies, etc. Be one of the millions of Americans that cannot get health insurance, and see how great the current how much profit can we make based system is.

 

The incentive to keep costs down is their budget is voted on every year. Unless we build a system that requires citizen A to only go to Doctor A, I don't see how the government would be the only choice. It would be the only choice in guaranteed payments to the Doctors. I would also envision people being able to spend their own money and visiting private Doctors as well.

 

Insurance companies have profit as one of their primary responsibilities, tell me how that helps patients get the best care?

 

If we cannot trust the government to cure a cold, should we trust them to execute citizens or what types of health care should be available and to whom?

[EvilMonkey]

I disagree that waste and inefficiencies are unique or even more so in government

 

If we cannot trust the government to cure a cold, should we trust them to execute citizens or what types of health care should be available and to whom?

 

There you go being so all-or-nothing again. Where there is money to be stolen, someone will find a way. It may be an employee embezzeling money, or it mau be someone cheating the system. Or it may be both. How about a system that is designed to not catch cheaters? We talked about school lunches in a different post. KNow how they qualify you for a free lunch in schools? They ask you how much you make, and if you are working. The schools are not allowed to verify that info, they just have to take you for your word. Your kids shows up in the office sick, asks to call mom. School calls the home number, she isn't there. "Oh, she's at work", says the kid. Can the lunch now be taken away? Nope. It is a program set up to help those in need, being abused by people, and the beauracratic idiots who set the program up in the first place. Where is the accountability? Social Security, once designed to help us when we retire, now also helps drug addicts and people with disabilities. PLus, long ago the funds got co-mingled with the general revenue to prevent a budget shortfall, thus contributing to its almost inevitable demise as the money we all pay into SS goes to fund roads in Arkansas or a dam in Kentucky instead of what it was intended for. Locally, riverboat casino revenues go towards school funding. Well, they still go there, but the more they increased, the more they took away from other sources, leaving the total funding the same, or in some cases, less. Then current gov. Blago tries to tax them to death, resulting in layoffs, cutbacks (in the riverboats) and a DECREASE in the revenue generated from them, despite his much higher taxes. Even more locally, look at Chicago with the Hired Trucks crap, or even just the asphalt scandals. Where there is money to be made, someone will try and find it. Not everyone is bad, but there are enough to make you wonder.

 

Oh, and I will agree with you that inefficienceies are not limited to governmental employees/programs. I have come across many places that I wonder how they are still in business.

[Texsox]

All valid concerns and ones I think we can contain. The school funding issue is so true. The slight of hand is wrong. There wasn't a net gain or corresponding decrease in tax rate to accommodate the lottery. I also agree that increase costs hamper businesses, especially small business. Health costs are a big expense for small business, which is why I think we need to improve the system.

 

At least in Texas, when we first moved here, you needed to show evidence of being on some sort of assistance (Lone Star Card). There is so much poverty here that well over 85% of the families qualified for free or reduced cost lunches. Which is why the school board decided it would be cheaper to just give everyone a free lunch. Is was costing almost the same to collect and account for the money as they were taking in.

 

Currently yours and my health care is being determined by an insurance company which is trying to maximize profits for their share holders. The insurance company employs medical professionals to look over the Doctor's shoulder and make certain he isn't spending too much on your care. They are sitting states away and deciding on your treatment. This system is flawed as well.

 

For the sake of debate, let's say there will be waste and inefficiencies beyond what the private sector would have. Do you think it would be more than the profits the insurance company is making and which would be better for your care? Over treatments and possibly needless tests or under treatment and refused treatments?

 

I agree this is a daunting task, unrivaled in history. I also think Americans can make it work. We need to find a way to cover the working poor. Those people working 40 hours a week at $6, $7, $8 per hour who cannot afford private insurance.

 

And sorry for the capital punishment reference. I always find it interesting the varying levels of trust people have for our government. I don't trust them to execute citizens, but would trust them to oversee a single payer health care program.

[LowerCaseRepublican]

There you go being so all-or-nothing again.  Where there is money to be stolen, someone will find a way.  It may be an employee embezzeling money, or it mau be someone cheating the system.  Or it may be both.  How about a system that is designed to not catch cheaters?  We talked about school lunches in a different post.  KNow how they qualify you for a free lunch in schools?  They ask you how much you make, and if you are working.  The schools are not allowed to verify that info, they just have to take you for your word.  Your kids shows up in the office sick, asks to call mom.  School calls the home number, she isn't there. "Oh, she's at work", says the kid.  Can the lunch now be taken away?  Nope.  It is a program set up to help those in need, being abused by people, and the beauracratic idiots who set the program up in the first place.  Where is the accountability?  Social Security, once designed to help us when we retire, now also helps drug addicts and people with disabilities.  PLus, long ago the funds got co-mingled with the general revenue to prevent a budget shortfall, thus contributing to its almost inevitable demise as the money we all pay into SS goes to fund roads in Arkansas or a dam in Kentucky instead of what it was intended for.  Locally, riverboat casino revenues go towards school funding.  Well, they still go there, but the more they increased, the more they took away from other sources, leaving the total funding the same, or in some cases, less.  Then current gov. Blago tries to tax them to death, resulting in layoffs, cutbacks (in the riverboats) and a DECREASE in the revenue generated from them, despite his much higher taxes.  Even more locally, look at Chicago with the Hired Trucks crap, or even just the asphalt scandals.  Where there is money to be made, someone will try and find it.  Not everyone is bad, but there are enough to make you wonder.

 

Oh, and I will agree with you that inefficienceies are not limited to governmental employees/programs.  I have come across many places that I wonder how they are still in business.

 

I wonder how much of the cronyism and corruption that goes on in government is due to the incredibly high cost of advertising and running a political campaign. Television advertising, radio spots, flyers, etc. etc. etc., it costs a pretty penny. So more and more our candidates of both parties are being forced to pander to make contributors give them cash (usually in exchange for promoting that contributor's agenda) To run for President now, you need to be a Steve Forbes type with millions in your own private coffers to use or pander to large donators. And wouldn't you know...Congressmen who get a whole ton of money from major interests seem to vote and promote an agenda for those interests (even at times when it is at the public's expense)

 

Since the public technically owns the airwaves, candidates should be given free time on TV for advertisements and debates for all candidates instead of the insipid 2 party stuff (Greens, Constitution, Libertarians, et al...) That way, they have no incentive to be forced to pander like they do. It gives them a better opportunity to create their own platforms instead of having their arms twisted by needing lots and lots of campaign contribution cash.

 

I believe our government is competent -- they just need somebody (i.e. the informed public and the media) riding their ass to keep them in line when they do go about overstepping their bounds.

[Rex Kickass]

I wouldn't trust it merely because it would be run by the government.  The waste and fraud would rival that is any current federal moneypit, probably topping the next 2 or 3 combined.  It's bad enough they run my retirement, try to run my business and keep trying to intrude into my life, get out of my doctors office.

 

Neither party is very good about getting out of the doctor's office. Just ask the people trying to protect the medical records at Planned Parenthood.

[LowerCaseRepublican]

Neither party is very good about getting out of the doctor's office. Just ask the people trying to protect the medical records at Planned Parenthood.

Technically, if they wanted to -- Under 215 of the Patriot Act...They can seize any "tangible records" (doctors records, financial records, etc. etc.) And due to the Act, they no longer have to show that the use of Sect. 215 would be probable cause but simply that any evidence would be "relevent" to a possible or ongoing investigation. Of course, if the expanding of the FBI powers goes through Congress, even the feeble FISA court oversight for this goes out the window and the FBI gets administrative subpoenas without any governmental check and balance for their activity.

[Balta1701]

Since we're specifically discussing administrative costs, let me point this one out again...

 

"This one will blow some minds. Despite being a bureaucratic leviathan or whatever, America's administrative costs are 300% greater per capita than Canada's."

[EvilMonkey]

Currently yours and my health care is being determined by an insurance company which is trying to maximize profits for their share holders. The insurance company employs medical professionals to look over the Doctor's shoulder and make certain he isn't spending too much on your care. They are sitting states away and deciding on your treatment. This system is flawed as well.

 

 

Kinda OT, but I am on sort of a different plan, sort of like a medical savings account. Get $1000 per year, no questions asked. After that, the next $4000 is all me. Then after that, it is 80/20. For the last 3 years, haven't gone over the $1000 (anything left gets rolled into the next year, with a $3000 maximum carryover). I spend a little more time choosing my doctors (I have one by my house, and one by my work, since I work too damnmuch). The work doc is more expensive, but when time matters, I go there. otherwise, I wait and use my less expensive guy. I tell the docs upfront that I am paying for this, I need straight answers and stuff, and so far they have been pretty honest with me.

 

 

I agree this is a daunting task, unrivaled in history. I also think Americans can make it work. We need to find a way to cover the working poor. Those people working 40 hours a week at $6, $7, $8 per hour who cannot afford private insurance.

While I will agree that the people you mention above need some help, if you dig into data, you will find that alot of people without insurance are not in that class, but rather younger people, 18-30 who COULD afford insurance, but choose to spend the money elsewhere (vacations, new car, whatever). The Sun-Times ran a piece about that several months ago, interviewing all these people that just thought nothing THAT bad could happen to them, so why waste all that money on insurance.

[Texsox]

Are you able to do anything for your employees? That's where I think the greatest benefit to our economy would come. By making small business competitive in benefit packages, talented employees would be more willing to start or go to work for a small business.

[KipWellsFan]

This isn't worse?

 

 

The fiscal austerity of the 90's, which helped drop costs of the program, did make for a worse health care system, or at least one that netted less satisfaction. Wait times for elective surgeries increased, though it should be noted that Canadians wait, on average, less time for vital operations such as transplants.

 

Cost: In 1970, the year before Canada's health care system came online, Canada and the US spent about the same on health care, 7.2% and 7.4% of GDP respectively. By 1990, it was 9% and 11.9%. And by 2002, it was 9.6% and 14.6%. So while our health care spending shot up by 7.6% of GDP and still doesn't cover out citizenry, theirs had a 4.5% climb and got everyone in the goddamn country covered (remember: the first number is pre-universal health insurance). During the 90's, Canada's health care costs (as a % of GDP) actually dropped. Dropped!

 

Americans don't die as a result of poor healthcare rules?

[EvilMonkey]

Are you able to do anything for your employees? That's where I think the greatest benefit to our economy would come. By making small business competitive in benefit packages, talented employees would be more willing to start or go to work for a small business.

 

I have a policy for my salesguy, costs about $400 per quarter. Doesn't cover general doc visits, but if he breaks an arm, he is covered. So if he gets a cold, he doesn't go running to the doc for some pills. But if he breaks something, he won't go broke (unless it is his legs, preventing him from driving and selling, and then he is s***-out-of-luck). Not the best policy, but better than nothing.

[Rex Kickass]

Anyone see "30 Days" on FX with Morgan Spurlock?

 

They were living on Minimum Wage jobs for 30 days, and both of them got sick - they went to the emergency room for a hurt wrist from manual labor jobs and a urinary tract infection. Between the two of them, their bill was nearly 1000 dollars - including a 40 dollar charge for an ace bandage.