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Canadian medical professionals react in disbelief, shock and horror to how things work in the US
July 20, 2012 1:11 AM   Subscribe

"I believed based on my politics that government mandated health care was a violation of my freedom." When a "die-hard conservative Republican" woman moves to Canada and encounters the universal healthcare there, hilarity ensues as cultures clash.
posted by MartinWisse (210 comments total) 67 users marked this as a favorite

 
When I asked for prayers for my little brother who had been burned in a camping accident, they were all puzzled why the story did not include immediately rushing him to the hospital.

Not as much hilarity as deep sadness.
posted by Zarkonnen at 1:17 AM on July 20, 2012 [25 favorites]


Yes. This is what happens when you don't call giving all the political power to (pharmaceutical and other) corporations "freedom", you don't have a ligitation-happy get-rich-quick legal system and you codify basic societal rules into laws and practises. This is what is known as sanity.
posted by likeso at 1:29 AM on July 20, 2012 [21 favorites]


I started to wonder why I had been so opposed to government mandated Universal Health care.

That would be ignorance.
posted by mattoxic at 1:30 AM on July 20, 2012 [64 favorites]


To me this reads as being less about national healthcare systems and more about an expat's growing awareness of how much the Republican party had been lying to her.
posted by ceribus peribus at 1:35 AM on July 20, 2012 [137 favorites]


mattoxic: "I started to wonder why I had been so opposed to government mandated Universal Health care.

That would be ignorance.
"

It's deeper than that. My wife, who grew up with US private healthcare and now lives here in the UK with me often says that the underlying driver of the whole sick, corrupted, inhuman healthcare apparatus in the US is the idea that getting sick is a personal failing and that you don't deserve to be cared for. What other insidious idea would make it an apparently reasonable decision to deny healthcare to someone because they had once been sick before?

I'm routinely asked why I didn't move to the US rather than her coming here, both by her friends and relatives and by people in the UK. People quite often are deeply surprised that I wouldn't take any opportunity to leave these rainy islands for the sunkissed mountains of Colorado. Then I tell them about 10 days holiday a year if you're lucky, laws which make it legal to fire someone for any reason you like with no comeback and $5,000 bills for an ambulance ride and they gaze into their cups of tea and say 'crikey'.
posted by Happy Dave at 1:37 AM on July 20, 2012 [178 favorites]


I've always felt that these are two under-appreciated points:

People actually went in for routine check-ups and caught many of their illnesses early, before they were too advanced to treat. People were free to quit a job they hated, or even start their own business without fear of losing their medical coverage

1. Early detection and prevention are huge cost savers, and generally lead to better outcomes. A well-funded public system is good at this sort of thing, because the government is big enough to make the appropriate inter-temporal trade-off: spend a little bit on prevention now, save a lot of money later. Market-based systems seem to be less effective at this, especially for folks who aren't well off: if you don't have enough money to pay for the preventative care now, then you can't have it and you will get screwed later. It's globally suboptimal for society and for most of the people within it, but it's rational behaviour on behalf of the unfortunate person who can't afford to pay now.

2. There are nasty knock-on consequences of having health care tied to employment. Until encountering the US health care system I had no idea that people would pursue jobs they hated rather than jobs they liked solely on the basis of health care issues. This seems bizarre to me, and I would have thought that overall it's a bad thing for the economy in addition to being a big source of unhappiness in people's lives.

It does make me feel lucky and grateful that I've never had to worry about these issues, and more than a little sad that Americans do have to put up with this.
posted by mixing at 1:39 AM on July 20, 2012 [50 favorites]


You're politics are wrong and are actively lying to the general public.

Full stop.
posted by Sphinx at 1:43 AM on July 20, 2012 [1 favorite]


But ... but ... it's COMMUNISM, PLAIN AND SIMPLE.
posted by GallonOfAlan at 1:48 AM on July 20, 2012 [1 favorite]


So I looked up the wikipedia page on naturopathy, which she mentioned as having been her familie's prior "care plan".

The philosophical and methodological underpinnings of naturopathy are sometimes in conflict with the paradigm of evidence-based medicine (EBM).

W.T.F.
posted by Chekhovian at 1:55 AM on July 20, 2012 [4 favorites]


Goddamit, my phone auto corrected your to you're.

Your politicians are wrong and are actively lying to the general public.
posted by Sphinx at 1:56 AM on July 20, 2012


I had a boss who berated me at length for both coughing and being foggy on prednisone/codeine when I'd returned from unpaid sick leave for pneumonia against doctor's orders because they claimed they couldn't do without me. The firm did not offer health insurance and I was told outright that most of "the girls" got it through their husbands. I paid through the nose for an individual plan. Things like diabetes and asthma are treated like they're mere symptoms of laziness. And the end result of those is an attitude that you shouldn't need preventive care because if you were making the right choices in the first place, you wouldn't have high blood pressure, high blood sugar, high cholesterol.

And everything else, we want to pretend just doesn't exist. That healthy young people do not have babies with neural tube defects and Down's Syndrome. That kids don't get cancer. That Personal Responsibility can take care of everything. But I think the big take-away here is that you cannot, at heart, have a family-centered life and a me-centered economy. If you want to be pro-family, you have to put your money where your mouth is and support the things that people need to have to raise families. You can't have a flat tax and remove government subsidies for health care and social support and those sorts of things and then expect women to rush out and have babies and stay home to depend on the income of a guy who could get laid off at any moment. People might be dumb, but they are just not that dumb. There's really no model of social conservatism that is compatible with economic neoliberalism on these issues.
posted by gracedissolved at 1:56 AM on July 20, 2012 [102 favorites]


A form of universal health care would be great for the US.

Obamacare is a corrupt disaster which makes US health care much worse.
posted by caclwmr4 at 1:57 AM on July 20, 2012


Obamacare is a corrupt disaster which makes US health care much worse.

I know many people with previous conditions, young people who would have been thrown off insurance were it not extended, and people whose insurance would run out were it not for Obamacare removing the cap on payouts that would disagree with you.
posted by Bunny Ultramod at 2:04 AM on July 20, 2012 [101 favorites]


Just an FYI for you Yanks. We still have to pay for our medication, dental work, and eye care. But most provinces have free dental for children up to a certain age. And there is a bit of talk by politicians about setting up a national drug plan (which would be political suicide in the states.) So yeah it's pretty sweet up here.
posted by Brodiggitty at 2:05 AM on July 20, 2012 [4 favorites]


Yes. This is what happens when you don't call giving all the political power to (pharmaceutical and other) corporations "freedom", you don't have a ligitation-happy get-rich-quick legal system and you codify basic societal rules into laws and practises. This is what is known as sanity.

And most importantly, when you don't have large masses of politically empowered ideological nitwits, like the author of this article used to be—the ultimate reason why the US cannot have nice things.
posted by fleacircus at 2:07 AM on July 20, 2012 [12 favorites]


Just an FYI for you Yanks. We still have to pay for our medication, dental work, and eye care. But most provinces have free dental for children up to a certain age. And there is a bit of talk by politicians about setting up a national drug plan (which would be political suicide in the states.) So yeah it's pretty sweet up here.

Drugs are pretty much free on the NHS in the UK.

Canadian expat living in the UK moving to the US. I am now familiar with all three systems. The UK wins on universality but I'd say it comes in last in terms of quality particularly at the front line where the doctors often strike me as a bit dumb and nurses can demonstrate a shocking lack of basic hygiene but then their education is fast and their pay is very low. Free medication is huge now that almost illness are treated with meds rather than physical interventions.

Canada has good solid professional care but an awful lot is actually not covered when you look closely. Without a drug plan you can still be bankrupted by serious long term illness. Doctors and nurses are smart, competent and well trained and well paid.

The U.S. - I am still reading all the damn paperwork. I expect I'll die before I figure it out.
posted by srboisvert at 2:14 AM on July 20, 2012 [11 favorites]


It's hard to quantify what free NHS healthcare has done for my close family (I'm in the UK), at least in financial terms. But reading that article made me think about how many times we've been helped. Here's a brief, incomplete list:

It's just treated my father in law's cancer.
It treated his cancer in the 1990s.
It treated my father's cancer, again twice.
It kept my father alive when he had a serious accident a couple of years ago.
My cousin and aunt have both had masectomies and breast reconstructions because of breast cancer.
All of these people are still alive.
I've been treated twice for depression.
It made sure my son didn't die when he was born prematurely.
It covered numerous bran scans and long-term EEC monitoring when it looked like he might have serious epilepsy.
It rebuilt my nephew's back.
It kept my uncle alive long enough for him to say goodbye to everyone when a brain tumour more or less exploded inside his head.
It rebuilt another niece's tummy and insides because she was born with her intestines hanging out of her abdomen.

And we have friends who have been rebuilt, cured, supported, patched together and helped to prevent small things turning into much bigger things - more than I could possibly list.

And I'm pretty sure that none of us had these things happen because we were exercising our personal freedom. None of us got ill or injured because because of some moral failing.

Contrast that with a friend who moved to the states and within a few days collapsed with a brain tumour. If his new employer (he's a gardener) hadn't promised to, and then actually paid the best part of $100,000 out of her own pocket, what would have happened? In her words to him, 'the US healthcare system would have stood and watched you die'.

Free universal healthcare comes with its compromises and its failings, sometimes lots of them, but it's human, and it at least tries to put humans first.
posted by dowcrag at 2:23 AM on July 20, 2012 [38 favorites]


It's the solid consensus of the people I've known in all the Insurance Businesses other than Health Insurance that their industry was never capable of handling the complexity of medical coverage, and the need to show a profit made it even worse (and most of them, including my late father, a Liablility Underwriter for 25 years, were otherwise very Republican).
posted by oneswellfoop at 2:23 AM on July 20, 2012 [1 favorite]


My wife, who grew up with US private healthcare and now lives here in the UK with me often says that the underlying driver of the whole sick, corrupted, inhuman healthcare apparatus in the US is the idea that getting sick is a personal failing and that you don't deserve to be cared for.

On preview, yep: Things like diabetes and asthma are treated like they're mere symptoms of laziness.

Thirding that. I've told this story here before, but in Finland, I had a torsioned ovarian cyst burst (OH HAI PAIN), nearly died from it, and most of my family – deeply conservative folk – responded with variations on "why didn't you die? If it happened to you it's because you deserved it."

When I tell people in Europe – men included – how there's no mandatory paid maternity leave in the US, they nearly go through the roof when it finally sinks in that it means there are in fact women who go back to work about a week after giving birth, if not mere days afterwards.

From the article: Even for hospital births. In Canada, midwives and doctors were both respected, and often worked together.

Same here in France. And, as I repeat as often as possible because it directly addresses the canard of "no free choice", we also have free choice of our health care providers here. I didn't in Finland, but like the woman in the article, I never had an issue with it. I have heard that it's more of an issue in the UK, yes.

Also, in France, with only government coverage, we do still have to pay for opthalmology and dentistry. However, you can also buy private supplemental coverage, cost-controlled by the government by requiring those providers to be not-for-profit. So it only costs 20-40 euros/month to get pretty much everything covered. For 20/month, I pay zero for medications, GP visits are entirely reimbursed (the gov't program "only" reimburses 60% of them, but they only cost 22 euros), bought some prescription eyeglasses a few years ago for 6 euros out of pocket, and get one free dentistry checkup every year.

Again from the article: Here in Canada, everyone was covered. If they worked full-time, if they worked part-time, or if they were homeless and lived on the street, they were all entitled to the same level of care if they had a medical need.

I read an article recently about a tuberculosis outbreak in Florida that could have been prevented by that... and, it must be said, by viewing the homeless as human beings, sigh. Worst TB outbreak in 20 years kept secret.
A single schizophrenic patient had circulated from hospital to jail to homeless shelter to assisted living facility, living in dorm housing in many locations. Over and over, the patient’s cough was documented in his chart, but not treated. It continued for eight months, until he finally was sent under court order to A.G. Holley. That year, 2008-2009, a total of 18 people in that community developed active tuberculosis from the strain called FL 046 and two died. The CDC sent a $275,000 grant to help pay for the staff needed to contain it.
posted by fraula at 2:26 AM on July 20, 2012 [12 favorites]


"Obamacare is a corrupt disaster which makes US health care much worse."

30 million previously uninsured Americans and future generations who won't be dumped by their health care provider because their illness is too expensive disagree.
posted by bardic at 2:26 AM on July 20, 2012 [23 favorites]


30 million previously uninsured Americans and future generations who won't be dumped by their health care provider because their illness is too expensive disagree.

I'm glad that PPACA is getting people coverage when they couldn't, and helping to protect people from some of the abuses perpetrated by the insurance industry, but as one of those 30 million I am not in any way excited to start spending money on an insurance plan that's going to have absurd deductibles and copays and exist for no reason other than so Obama can say he got me health insurance. I worked at Wal-Mart for awhile, and I remember the health insurance they wanted to sell me; it was literally one doctor in town, and the copays and deductibles were so high that nobody living on a Wal-Mart paycheck could so much as get a checkup and eat in the same month. That is the kind of insurance that we in the 30 million have to look forward to; sorry for not being grateful.
posted by Pope Guilty at 2:34 AM on July 20, 2012 [20 favorites]


"I believed based on my politics that government mandated health care was a violation of my freedom."

I'm not laughing. I'm not even crying. I'm numb. Someone else mock this person's smug prior beliefs and how they were, and continue to be, projected large upon the nation. I'm going to go hit something.
posted by JHarris at 2:34 AM on July 20, 2012 [2 favorites]


"And the end result of those is an attitude that you shouldn't need preventive care because if you were making the right choices in the first place, you wouldn't have high blood pressure, high blood sugar, high cholesterol."

It has gotten to the point where any time I hear someone ranting about how other people "make the wrong choices" I just assume they are a right wing idiot and tune them out. Seriously, if you ever listen to folks on that side, on talk radio or on blog comments or in religious contexts or whatever, it's a constant stream of "those other people are poor/physically ill/unemployed/mentally ill/disabled because they made wrong choices."

Some people do make terrible choices in their lives and face painful consequences because of it -- but, you know, I don't want to live in a place where people aren't allowed to make mistakes without being considered the scum of the earth. And this constant stream of "wrong choices wrong choices wrong choices" just gives people an excuse to treat others as non-humans.

Funny how often the people who say this self-identify as Christian. (And this is one of the reasons why I no longer do.)
posted by litlnemo at 2:44 AM on July 20, 2012 [25 favorites]


I don't often share links with political content on my Facebook wall, but using the pull quote that makes it seem like this is going to be a critique of the Canadian system might be enough to make some of my more conservative friends actually read the article through without immediately shutting down.

Then they'll get to the place where it says she's an escaped Quiverfull person and they'll dismiss it as the rantings of somebody bitter at Christians, but at least they'll have read it.
posted by Joey Michaels at 2:45 AM on July 20, 2012


'm not laughing. I'm not even crying. I'm numb. Someone else mock this person's smug prior beliefs and how they were, and continue to be, projected large upon the nation. I'm going to go hit something.

Pointless, mocking them would you enrage the person.

The frustration arises from the idea that it's impossible to change preconceived notions, so any effort is doomed and futile. Actually, the belief that healthcare=socialism is an implanted one, repeated over and over and over again, suggested and suggest and suggested again.

So, it can be switched. People believe en-mass god actually exist, and if they still do is only because it's still being drumbeated.
posted by elpapacito at 3:03 AM on July 20, 2012


Speaking of quiverfull, there must be a special place in heck for people who believe both that a) women are there to get as many kids as possible, b) therefore contraception and abortion are evil and c) health care insurance is something left to the individual because the combination ensures there are a lot of women dying in childbirth because they have too many babies too fast after each other and are too poor to have the health care they need.
posted by MartinWisse at 3:03 AM on July 20, 2012 [7 favorites]


What continues to amaze me is that, while you now have a situation where both the leading candidates for President have had a programme that approaches universal healthcare (at the very least) under their belts - which, in any sane political setup, would imply that healthcare is a done deal in political terms - you nevertheless have a situation where it still is so unpopular, that one of them is minimizing his achievement, while the other is actively running to scrap it. It completely and absolutely boggles my mind.

(Also, you can be sure this setup will be considered as a standard for other nations, if the Coalition's tweaking of NHS is any indication of things to come in the rest of the world. )
posted by the cydonian at 3:12 AM on July 20, 2012 [3 favorites]


One idea is that we all help each other. Another idea is that it is everyone for himself.

To fully embrace the latter idea, any idea of species identity has to be forgotten. It's not just humans who have to go it alone, it's every living creature. Dogs should not form packs, Fish should not join schools. Cattle are unherd-of. We should believe that no living creature finds benefit or comfort by consorting with other living beings of its kind.

It's a peculiar idea of the modern ape-derivatives that each and every one of them has succeeded without the help of the others. That particular conceit is peculiar to these modern ape-derivatives, and has no corresponding form in other species. Most living beings recognize the need to bond with similar living beings, but humans talk too much and think too much to remember that.
posted by twoleftfeet at 3:22 AM on July 20, 2012 [10 favorites]


As a UK-based person, I have real difficulty understanding why (the majority of?) Americans are so against universal healthcare. What does health insurance give you that something like the NHS wouldn't? The whole 'socialism wah!' explanation doesn't really explain much to me, so could someone break it down for me and tell me why it's such a bone of contention?

I mean, surely you'd much rather spend a bit more on taxes and get care as and when you need it than run the risk of losing your house because you got cancer? I'm also amazed by the stories on ask.me where people say things like 'I've just gouged my hand with a steak knife and I'm bleeding like a stuck-pig but I've got no health insurance. What do I do??'. How is that a good thing?
posted by Scottie_Bob at 3:28 AM on July 20, 2012 [4 favorites]


Scottie_Bob: "I mean, surely you'd much rather spend a bit more on taxes ..."
You lost them right there.
posted by brokkr at 3:34 AM on July 20, 2012 [15 favorites]


I mean, surely you'd much rather spend a bit more on taxes and get care as and when you need it than run the risk of losing your house because you got cancer? I'm also amazed by the stories on ask.me where people say things like 'I've just gouged my hand with a steak knife and I'm bleeding like a stuck-pig but I've got no health insurance. What do I do??'. How is that a good thing?

More bizarre thing about this in a supposedly all about the money USA: it's actually better for the economy that this wound gets fixed and the patient goes back to work.

I'm not entirely sure that a part of the US body politic doesn't want to keep private healthcare precisely to punish 'bad choices' rather than see other people they don't like get health care. It's vaguely surreal to look at it from outside.
posted by jaduncan at 3:37 AM on July 20, 2012 [8 favorites]


The whole 'socialism wah!' explanation doesn't really explain much to me, so could someone break it down for me and tell me why it's such a bone of contention?

Believe it or not. The Cold War did incredible psychological damage to the US to an extent that it's hard to really explain to a non-American.

The other side of things is that Americans are basically constantly lied to about universal health care; this is going to sound insane, but there's a shockingly large contingent of people who honestly believe, or at least want to believe, that people who live in nations with UHC are routinely euthanized, or that you have to wait for weeks or months to get an appointment, or that UHC means people simply don't have access to care. I'd guess that at least half and probably more like 3/4 of the aggregate knowledge possessed by Americans about UHC is simply lies, told to preserve the structure of privilege and exploitation that our system is built on.
posted by Pope Guilty at 3:37 AM on July 20, 2012 [62 favorites]


The whole 'socialism wah!' explanation doesn't really explain much to me, so could someone break it down for me and tell me why it's such a bone of contention?

In addition to the higher taxes thing, the one thing that outrages most Americans more than anything is the idea that someone, somewhere is getting something they don't deserve on the taxpayer dime. The average American really does prefer to go bankrupt or see their whole family starve than to know that one of Those Lazy People got something they didn't deserve.
posted by dirigibleman at 3:41 AM on July 20, 2012 [27 favorites]


Pope Guilty: there's a shockingly large contingent of people who honestly believe, or at least want to believe, that people who live in nations with UHC are routinely euthanized, or that you have to wait for weeks or months to get an appointment, or that UHC means people simply don't have access to care. I'd guess that at least half and probably more like 3/4 of the aggregate knowledge possessed by Americans about UHC is simply lies, told to preserve the structure of privilege and exploitation that our system is built on.
I do wonder what people in the US imagine health services in Europe and Canada are actually like. My guess is they picture Ethan from Lost in his scary underground clinic smiling creepily while holding a giant rusty needle.

It's not quite like that. I mean, the receptionist at my NHS clinic isn't exactly what I'd call friendly, but if you call up at 9 you can usually get an appointment with a doctor in the afternoon, and it's free.
posted by Sonny Jim at 3:52 AM on July 20, 2012 [2 favorites]


On an intellectual level, I get the taxes thing and I get the 'undeserving poor' (or should that be 'life happens'?) thing, but emotionally, I just can't square the circle. I've had conversations with American friends of mine that went along the lines of 'I take care of myself. Why should I pay for someone to get heart surgery when they're a 40-a-day, burger-eating, beer-swilling, exercising-fearing, couch potato? No thanks'. As a Brit (well, a Scot ;) ), my feeling is that it's a very different mindset here and one that, while perhaps not totally accepting of something like the aforementioned scenario, is more charitable. Additionally, you never know what life has in store for you. You might be a triathlon-running fitness fanatic who only ever eats vegetables and rice and doesn't smoke, but you could still get run down/get cancer/get depression/get pregnant/*insert other significant health issue here. The couch potato is still covering you, and vice versa. Is the perceived inequality that big a deal?

The NHS isn't perfect, I'll give you that, but I'd much rather get some serious life-threatening condition here knowing that I won't have to be fighting a war on two-fronts: one with my condition and one with my insurance company to cover the costs. The way I see it is that health insurance isn't there to provide care, it's there to make money. The two are fundamentally on opposite sides.

@Pope Guilty - I have heard about the fall out post-Cold War, but I've never really understood it or read up that much on it. Is it really that bad? I feel like this is a big part of the American psyche I really don't know anything about. On your other point, there must be resources which demystify the whole universal health care system, with a view to the American public.

@Jaduncan - surreal would be a good way to describe the view from the outside looking in. Bizarre, mad, and ultimately (IMO) self-defeating might be some other ways!
posted by Scottie_Bob at 3:55 AM on July 20, 2012 [9 favorites]


Some people (not I) believe that a capitalist profit motive based system is required to provide the highest level of care. This seem to mostly refer to advanced high tech treatment for extreme cases, and pays little attention to preventative care.
posted by flaterik at 4:05 AM on July 20, 2012 [1 favorite]


30 million previously uninsured Americans and future generations who won't be dumped by their health care provider because their illness is too expensive disagree.

I think you mean insurer, not provider. Big difference, and gets to the heart of PG's statement. As much as I think ACA is a step in the right direction, it, in fact, does piss little to make health care less costly. It largely targets the insurance side of the equation, and, really, doesn't do much to make it very affordable. Sure, there is the option for the government-funded exchanges, but, since they don't actually exist yet, they're best regarded as vapor-ware.

Until concrete measures are taken to address and reign-in health care costs, the US will remain a medical basket-case.
posted by Thorzdad at 4:05 AM on July 20, 2012 [4 favorites]


I do wonder what people in the US imagine health services in Europe and Canada are actually like. My guess is they picture Ethan from Lost in his scary underground clinic smiling creepily while holding a giant rusty needle.

A lot of conservatives just don't care if it's better, they have a visceral emotional reaction to the idea of government healthcare and the details don't matter. Even if it's is good health care, it's bad because it comes from the government. We've had thirty years of Reagan philosophy drummed into our heads that government is the problem not the solution and that all taxation is theft and it's really hard to convince a lot of people now that anything the government does is good.
posted by octothorpe at 4:07 AM on July 20, 2012 [9 favorites]


completely forgot to include: title is from here. Carry on.
posted by MartinWisse at 4:13 AM on July 20, 2012


Life is supposed to be hard. If you make it too easy, people get soft. This can adversely affect the moral fiber of this great nation. America will fail if you don't raise a hardy and stalwart people who are aware of the risks of not being hardy and stalwart. And those risks must be real, in the form of bankruptcy and death or else it's just talk.

And that's how we are building the best of all possible worlds.
posted by dglynn at 4:36 AM on July 20, 2012 [7 favorites]


I took my son to the Royal Children's Hospital in Melbourne on the weekend, basically because our GP was unsure of his diagnosis and wanted a second opinion and scan. We were there for about four hours. My son received a course of treatment in a room we had to ourselves, and some medicine to take home. the hospital itself is brand new first class facility, staffed by well trained professionals who smile relentlessly.

It did not cost me a cent.
posted by awfurby at 4:37 AM on July 20, 2012 [2 favorites]


As a UK-based person, I have real difficulty understanding why (the majority of?) Americans are so against universal healthcare.

From the perspective of the 80% who are insured, their self-image is that of a responsible person who works hard, makes sure to have health insurance, and tries to stay one step ahead of his health problems. Someone without health insurance is perceived to be doing something wrong, and they don't want to be on the hook for the other person and the rest of that 20%. You can explain how it's better for everyone overall if everyone is covered, but they'd rather cut off their nose to spite their face, or at least decide that what they have now is better than having to deal with unknown consequences of universal coverage in the future.

On the other hand, people without health insurance who are themselves against universal health coverage? I don't understand them and I can't understand them.
posted by deanc at 4:44 AM on July 20, 2012 [4 favorites]


I have often had head scratching arguments with people online about UHC and this article helps me understand to some degree. I don't understand the less choice aspect since we chose our family doctor and always have been able to. I want to try so hard to understand this point of view because UHC are not fighting words to me. I just had two eye appointments where I walked out without a bill.

We once met a man in Seattle while travelling. He had a gigantic, golf ball sized benign abscess on his face. He had finally saved up the $15K it was going to cost to have it removed. I felt so sorry for this poor young man because I knew back home it would have been taken care of when it was a bump.

An American friend who moved here from the South constantly wonders if his Dad would be alive if UHC had been available. When you come from a place where the median income is $10K, daily survival seems more important than long term health :S
posted by Calzephyr at 4:49 AM on July 20, 2012


My brother had a brain tumour for the last year, and needed radiation treatment and surgery to remove it. My middle-class family was not bankrupted by this, and he doesn't have any risk of being cut off healthcare in future for a 'pre-existing condition'

There is a reason I keep hoping that horrible, horrible things happens to the Republican party in the US. That might change you from 'Scary right-wing' to merely 'More right wing then the rest of the planet'.
posted by Canageek at 4:50 AM on July 20, 2012 [1 favorite]


It's worth mentioning that publicly sponsored health care and a private health industry are not incompatible.

Brazil has a rather poor public health system -- the doctors are just as good, and standard treatments are standard treatments, but non-emergency (i.e. ambulatory) care requires standing in line -- actually, getting future dates; it can take months -- and the chairs in waiting rooms suck.

But both my parents have had surgery under the public system, and were very well cared for. You just don't have much privacy -- no individual recovery rooms and all.

Now, some jobs go the extra mile and give you private insurance as a perk, so I know both systems. (My parents were always self-employed) This is is particularly useful because I need to have frequent blood panels to check for lithium levels and thyroid function, and that'd be hard to get with an order from my out-of-pocked paid for, handpicked pdoc -- I'd have to enter the public mental health system, yadda yadda yadda.

So... would a better public health system be a good thing? I believe so, but public policy for a 2 x 106 people country without strong component states is a frakking mess. I know this thing up close, I've developed procurement algorithms, etc. But anyway, we also have a vibrant private insurance, private labs and private consulting doctors, enough that a great pdoc can refuse insurance coverage (probably a tax thing) and yet have a full schedule.
posted by syntaxfree at 4:51 AM on July 20, 2012 [1 favorite]


Recent trips my immediate family and friends have had to public hospitals:

- close friends' 11 months old baby wheezing and struggling for breath; taken to emergency; 24 hours of treatment-waiting-assessment cycle; paid only for the medication they picked up on the way home.
- my father had a lung infection with complications from emphysema and high blood pressure: small hospital in country town called the Royal Flying Doctor service to get him to capital city public hospital by small plane; 3 days in high-dependency unit, 2 in standard ward; covered by Medicare. Not sure what ongoing medication will cost, but it will be on the national Pharmaceutical Benefits Scheme, so not the full price.
- husband had suspiciously odd-looking mole removed as he's a high-risk group for skin cancer and doctor decided better safe than sorry; about $100 after health insurance.
- father-in-law had to rush to emergency with a detatched retina; he was fixed and driving again within a few days. Covered by health insurance, paid a small excess.

Preventative care, emergency care, possible congenital defect, completely self-inflicted problem: all received care that wasn't by any means glitzy or special, but competent and delivered by people who understood the stress of the patients and their families. You could have this, America! Obamacare is a good start, but if more women like the one in the FPP could be shown the truth you could have it even better.
posted by harriet vane at 5:00 AM on July 20, 2012


syntaxfree: "It's worth mentioning that publicly sponsored health care and a private health industry are not incompatible."

Seconded. I'm British and have had private healthcare through two jobs in the past. I've used it once. The premium was paid by the company and was £40 a month. I had a £6000 surgery (zero additional cost) and paid £14 for some painkillers that weren't covered. Oh and they paid for the taxi home after the surgery.

Private healthcare in the UK is quite good, if you want it. It has to be - it's competing with an alternative that everyone has already paid for - the 'free' NHS. The idea of a 'co-pay' or the insurance not totally covering you would be crazy. What would be the point?

Most critically, healthcare has never factored into a single life decision for me aside from deciding not to move the US - taking a job, leaving a job, moving cities, nothing is considered with healthcare as a major issue in that decision. It's just a given. The amount of mental energy we don't spend thinking, arguing and crying about healthcare in the UK is worth the budget spent on it alone.

Actually I take that back - it's factored very strongly into one decision. I switched my vote from the Lib Dems in the coalition government to the nationalist party in Scotland. I'm pretty sure if the Tories had their way we'll have a US style system in England and Wales inside of a decade. Whatever other arguments there may or may not be for independence, preserving the Scottish part of the NHS as an actual functional universal care system is a pretty worthy goal.
posted by Happy Dave at 5:02 AM on July 20, 2012 [9 favorites]


Most Aericans would rather use their tax money to kill brown people on the other side of the world than save their own children back home.
posted by blue_beetle at 5:13 AM on July 20, 2012 [5 favorites]


I think the vast majority of people in this thread don't get the electoral calculus of single payer healthcare. It only works in a Rawlesian context. For a majority of Americans the existing "employer provided care when working, single payer at retirement" provides a similar or better level of care to single-payer systems. The problem is the dispersion of health outcomes. That and people in the "think they are appropriately insured but really aren't if shit goes bad" are not able to figure that out until its too late.

We need single payer healthcare because everyone needs the best level of care we as a society can afford, but it's a bit simple to say " americans don't want single payer because they are dumb and they have been lied to". The real reason is that a large segment of the population are selfish pricks who can't contemplate a scenario in which single payer benefits them given their current economic system.
posted by JPD at 5:18 AM on July 20, 2012 [4 favorites]


System= situation
posted by JPD at 5:19 AM on July 20, 2012


I started to wonder why I had been so opposed to government mandated Universal Health care.

That would be ignorance.
posted by mattoxic at 9:30 AM on July 20


Not forgetting the almost defining attribute of the conservative: a real inability to properly visualise and understand a situation until they actually find themselves (or a loved one) in that situation. Or, lack of empathy, to put it more succinctly.
posted by Decani at 5:19 AM on July 20, 2012 [14 favorites]


I am very happy that this woman has achieved a better quality of life: it sounds as if she was in a ghastly situation before and is now much better off.

As for those who continue to knowingly support the moral abomination that is the US healthcare system... For them, for those who condone the torment and death of their fellow human beings and try to dress it up as liberty because it makes them more money...

There are times when I wish that I believed that there was a hell, for surely they would be going there. In any just world, they would be on trial for crimes against humanity.
posted by lucien_reeve at 5:21 AM on July 20, 2012 [2 favorites]


On the other hand, people without health insurance who are themselves against universal health coverage? I don't understand them and I can't understand them.

I don't fully understand it, either, but the way I see it, health care isn't viewed as a right by many Americans. It's a privilege earned through work. It's okay to spend tax dollars on firefighters and police and soldiers for everybody because those are in the "god-given-rights" part of the national psyche. But not healthcare.

I've got an uncle who was recently injured on the job (head trauma). He's in his late 50s, early 60s. He'll never work again, certainly. He's seeing doctors and getting around using disability benefits right now. Sooner or later something will come up that disability won't cover, and I'm pretty sure that will somehow be Goddamn Obama's fault, and if we'd had universal coverage when the injury happened he'd probably be dead.

I just don't get it.
posted by uncleozzy at 5:23 AM on July 20, 2012 [1 favorite]


I just don't get it.

Why? What's so difficult to understand. You guys hate each other down there.
posted by larry_darrell at 5:36 AM on July 20, 2012


Someone mentioned Rawls. That's some Kant-flavored dope, mang.

I used to be a hardcore kantian -- and the road from there to Deleuze probably deserves a FPP reviewing the more important books I read in the process -- but the main thing here is that Deleuze replaces the idea of an essence with events. Rawls and Nozick and friends are always looking for the essence of a civil society, when a civil society is actually process in continuous development and evolution. No, really, look at it -- look at recent history -- look at it

This is also why you can get hung up by your "republican values" against life-saving medicine. These people want to be honest to the essence of what a honest, fair, strong society is, but you almost never get to use is in such a strong sense. To quote from "A thousand plateaus", "good and evil are the result of temporary selection, always to be renewed". And health is quintessentially an event, irreversible -- which is hard to square off with essentialist theories of ethics.
posted by syntaxfree at 5:41 AM on July 20, 2012 [2 favorites]


When I tell people in Europe – men included – how there's no mandatory paid maternity leave in the US, they nearly go through the roof when it finally sinks in that it means there are in fact women who go back to work about a week after giving birth, if not mere days afterwards.
I'm sure you know, but for all the folk watching along at home: regardless of maternity leave you choose to take, in England all women who give birth after the second trimester are lawfully compelled to not work for at least two weeks (four in some occupations). It's simply considered basic decency and safety not to have to work so soon after birth. This is true even for stillbirth (indeed all maternity leave is available for any stillbirth after the second trimester). The thought that a woman could and should have to work so soon after birth is alien.
posted by Jehan at 5:41 AM on July 20, 2012 [5 favorites]


I do wonder what people in the US imagine health services in Europe and Canada are actually like.

There are a lot of differences within those systems though. Britain, with it's NHS, actually is socialized medicine. But the Right paints Canada with the same brush, but single-payer isn't socialized medicine, it's socialized insurance. That's exactly what Medicare is, and would be a lot less scary to Americans, but the branding damage has been done.
posted by spaltavian at 5:44 AM on July 20, 2012 [6 favorites]


Not forgetting the almost defining attribute of the conservative: a real inability to properly visualise and understand a situation until they actually find themselves (or a loved one) in that situation.

I think it's more an unwillingness, rather than inability. There are plenty of very smart people who choose not to honestly explore the difficult situations that our healthcare system produces.
posted by sriracha at 5:45 AM on July 20, 2012


Just wait til she finds out about our mandatory same-sex marriage.
posted by oulipian at 5:49 AM on July 20, 2012 [15 favorites]


Many citizens of the United States think that limiting the powers of government over the individual is a key value. Someone very close to me is in daily horror since the Supreme Court upheld ACA, because he believes that it's government usurpation of individual rights. "It's the beginning of the end," he told me, "America won't be recognizable as a democratic nation in two generations."

I asked him if he was worried about socialism replacing democracy, and pointed out that our society is already paying for the uninsured: directly, through more expensive last-resort (often futile at that stage) treatment, or through the societal premature loss of an individual (often educated and nourished at public expense), or the fallout from the wreckage in the lives of the people who lost a core part of their social circle. I asked him if it wouldn't be better, since we're already paying these costs, to do so in a more efficient way. He thought, then agreed, but then said, "but Obamacare is NOT the answer. We need a different solution."

He's a partner in a small business. One thing about the ACA that's distressing him is that, while his company has the option of retaining their current excellent insurance, doing so will cost them an additional 8% of salaries in the form of tax. They'll probably have to drop the insurance, and go with ACA, because they have a small margin for survival as a business. This is the "lack of choice" that's concerning him, rather than concern over limited doctor options. To him, his choices are sign up for ACA, or go out of business.

This concerns me, because it appears that much of the initial funding for ACA is supposed to come from this tax revenue. I'm wondering if enough small businesses end up participating in, rather than funding, ACA, it may unbalance the funding plan. Any accountants or actuaries on the blue who have a better grasp on this care to reassure me?

Me? I'm all for universal health care. My family is a good example of the long-term costs of our current system in the United States. My mother died at 36 of cervical cancer. It's the most survivable cancer: very treatable in the early stages. Hers went undetected until its late stage because we didn't have health insurance; we were quite poor, and she had no gyn care for 9 years after the birth of her last child, when her obvious illness made her eligible for last-ditch government aid. By then, it was too late. Subsequent to her death, her 3 children were ill-nourished, poorly educated, and suffered various emotional traumas. All of us have had less education, more low-wage jobs, and more long-term health care costs because of her death. Some of us have been on government assistance, and/or had children before the age of 18. The US has lost the benefit of our taxes, our greater contributions as functioning adults, and incurred more expenses feeding and providing medical treatment some of the next gen of kids at government expense. Oh, and there was an expense to the judicial system as well, when an unparented kid grew up unable to guide her own child. Aside from how awful her loss was to us personally, it would have been a much more economically sound choice for the country to have just given my mom the damn pap smear.
posted by theplotchickens at 5:49 AM on July 20, 2012 [11 favorites]


Every time she used the word "freedom," I kept channelling Inigo Montoya.

"You keep using that word..."
posted by Dodecadermaldenticles at 5:57 AM on July 20, 2012 [3 favorites]


I get a lot of press releases in my email because I edit a local newsblog in Seattle. I got one yesterday that just makes me want to... I don't know. Weep?

"ARLINGTON, VA – Americans for Prosperity, the nation’s premier advocate for economic freedom with over 2 million members nationwide, today announced a major health care rally to be held on Capitol Hill Friday, August 3rd at 12 p.m. Featured speakers will include Congressman Paul Ryan, Jim Martin from 60Plus, Penny Nance from Concerned Women for America, and Tim Phillips, President of Americans for Prosperity.

“'While President Obama continues to force a trillion dollar takeover of health care, the fight is far from over,' said Tim Phillips, President of Americans for Prosperity. 'AFP is organizing this rally to make citizens’ voices heard and defend health care freedom.'


"Health care freedom." Yeah. Right.
posted by litlnemo at 5:59 AM on July 20, 2012 [1 favorite]


It's vaguely surreal to look at it from outside.

It's far more surreal from the inside, trust me.
posted by Forktine at 6:00 AM on July 20, 2012 [8 favorites]


"Health care freedom." Yeah. Right.

It's freedom from health care. Duh.
posted by uncleozzy at 6:01 AM on July 20, 2012 [4 favorites]


Concerned Women for America sounds like something straight out of The Simpsons. Amazing scenes.
posted by ominous_paws at 6:03 AM on July 20, 2012 [1 favorite]


"As a UK-based person, I have real difficulty understanding why (the majority of?) Americans are so against universal healthcare."

Guys, guys, guys, it's because if Stephen Hawking had been British and had to use the NHS, he would have DIED because COMMUNISM.
"People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."
Only our best-in-the-world American system of wasting a quarter of health care dollars on processing costs and paperwork and refusing to treat sick people can possibly provide adequate care for someone like Stephen Hawking!

(Which is to say, most Americans who are against universal healthcare have no idea how healthcare, universal or otherwise, works. It's also super-hard to convince a lot of people in the U.S. that there are things the government can do better and cheaper than private industry, because we've all been hearing since 1980 that government is expensive and corrupt and wasteful, and private industry is lean and mean and competitive and provides higher quality at a lower cost. In fact, I watched a charter school recently whose budget was basically predicated on the idea that though they weren't sure where it was, there MUST be fat to trim from public school budgets because government is inherently wasteful, so they'd just assume they could save 10% off the top of everything the public schools did. They ended up with a funding shortfall of more than twice that even with appallingly low teacher salaries, because, as it turns out, there's not a lot of fat to cut, and they weren't as good at doing things efficiently and inexpensively as government. But try to sell that to anyone; Americans just can't believe it.)
posted by Eyebrows McGee at 6:08 AM on July 20, 2012 [11 favorites]


A couple of months ago I had 2 moles removed that have been there for ages, just in case. I made the appointment a few days in advance and it was completely free. This is in the UK.
posted by lith at 6:10 AM on July 20, 2012


This is just to note that I'm 28, and without the parts of the ACA that have already gone into effect it would be impossible for me to have healthcare based on my pre-existing condition of psoriatic arthritis. Instead of being literally bed-ridden at 28 with severe arthritis, I have very decent, affordable (~$300/mo) health insurance that covers my ~$2000/mo medication.

I was rejected by every health insurer in my state. The high-risk pool provided by the ACA has literally saved me from early decrepitude. Also, my underemployed little brother has insurance thanks to being able to stay on my parents' plan longer, due to the ACA.

It's okay to criticize the ACA, but for me it's a step in the right direction. Literally.

Thanks, Obama.
posted by gilrain at 6:20 AM on July 20, 2012 [34 favorites]


What a lot of people seem to be missing is the fact that our politicians don't work for us anymore. Us being the "average" American.

Bought and paid for by vested interests; our politicians take their marching orders from the health care industry, are told to deride the idea of UHC as an infringement of our "freedoms," and willingly do so with their hands held out for cash.

A large portion of our population eats this drivel up, even though they have zero idea of what "freedom" actually is aside from owning guns so they can shoot whoever it is they think wants to take away said guns.

It all starts with campaign finance reform. Or a total societal collapse.
posted by Max Power at 6:28 AM on July 20, 2012 [2 favorites]


Interestingly but not surprisingly, the author of the linked article is also a member of the Spiritual Abuse Survivors Blog Network. She's been deceived about quite a lot for a very long time. Sadly, that will probably disqualify her story in the eyes of many who might really benefit from reading this article.
posted by Currer Belfry at 6:30 AM on July 20, 2012


I'm a 28 year old American. I have a heart condition called PSVT - paroxysmal supraventricular tachycardia. It's the sort of condition that can really affect your quality of life. I can be anywhere, anytime, and it hits. I can be active, excersiing and working, or inactive, literally lying in bed about to drift off to sleep. All of a sudden, my heart rate will spike to anywhere between 140-270 bpm and stay there for anywhere between 2-27 minutes. 27 minutes is the longest one I've ever experienced. Severe angina sometimes accompanies the attack, feeling like someone has taken a wide gauge needle, shoved it in my chest, and begun filling the cavity with boiling cement.

I can't get health insurance. Not possible. My work doesn't offer health insurance, because we are a small business and can't afford it. The best we can do is setup some copay covered GP visits and preventative care with a clinic in town.

So last year when an attack felt like I was dying, and I made it halfway to the ER before it stopped (and of course turned around, as I also can't afford an ER visit), I had to apply for a spot on a list that might cover some testing and medication. I had to lie on the form, because they counted the income of my co-habitating girlfriend at the time against my eligibility (the person preparing the form for me ripped up the first one and made me do it again, omitting her income) and was eventually accepted. As a result, I was able to get an ultrasound of my heart (I got to watch the valves flap an everything!), a wearable heart monitor to record an attack, and access to some cheap medication.

That was a year ago. The program I was in lasts for a year. I'm back to no-care now, and have very very few options.

Am I making bad choices? Fuck no. I quit caffeeine, quit smoking, quit eating bad food....it's an electrical malfunction. I was born with a shitty AV node. It ain't my fault. Yet here I am, terrified every day of another attack and the feeling of death. At age 28.

Of course, I could get the fairly simple radial ablation surgery and fix the issue once and for all. But of course, that would completely bankrupt me. I am poor, in the sense that I make less than the technical poverty line.

Would I like to pay more in taxes to get access to some fucking healthcare? Yes please.
Do I mind the idea of "government mandated healthcare" if it means I have any chance of obtaining affordable coverage despite my pre-existing condition? Fuck no.

I don't know why I'm sharing this. Just another anecdata point, I guess.

I really want to live in the UK. There's mah people. Sigh.
posted by lazaruslong at 6:36 AM on July 20, 2012 [24 favorites]


I haven't much about the definition of "Universal Health Care", but what exists in Canada really should not be held up as an example. I'll let Andre Picard tell it like it is.

Yes, health care is government mandated in most Canadian provinces, which means we do not have the right not to have health care. And, in most provinces, Canadians must pay monthly to their provincial governments monthly for health care (If you don’t, you don’t get health care and your bill will be sent to a collector). And even if you pay - your health care is extremely restricted. In B.C., on basic care, I can see a primary physician and the referrals given or testing that is covered under the medical health system (minimal options). This “universal” health care" costs from $30.00 to $70.00 a month. In some provinces, there is not monthly charge. I know many people who do not have health care because they cannot afford it. More and more, free clinics are appearing in our major cities.

If you work, you might be lucky to be offered “extended (private) health care”. For an additional $80.00 a month, I get the privilege to see a naturopath six times a year and 50% dental coverage. Yipee.

I waited over a year to see a specialist regarding a serious health issue. The specialists recommended surgery – which is another year’s wait, if I’m not bumped. If I was rich, I might choose to go to one of the exclusive local private clinics and pay for next day testing or next day surgery. Some people choose to go to the states for immeidate care (if they can pay).

We have primary physicians now that will only take you on if you live in their district. There are also other primary physicians that will refuse to take new patients if they have a chronic health condition (many Physicians “interview” new patients and decide if they will accept them or not). Thus, we have a mass amount of walk-in clinics, where you stand in line for hours and you do not have a choice of who you see.

I always get unnerved by these starry-eyed news articles about Canada’s so-called glorious health care system. This is NOT Universal Health Care. This is NOT a system to be admired.
posted by what's her name at 6:54 AM on July 20, 2012


$30.00 to $70.00 a month. $30.00 to $70.00 a month. This is a complaint? I don't know about the entire US, but I can tell you that many of us here would be seriously thrilled to have insurance that cheap.

Most of my Canadian friends don't paint quite the bleak image you do. I wonder why.
posted by litlnemo at 6:59 AM on July 20, 2012 [24 favorites]


One of the funny things is that here in the USA, we immediately associate "universal health care" with either (a) a fully state-run system like the UK's NHS, or (b) a single-payer system like Canada's. In fact most other western countries use a hybrid public/private system to fulfill their universal health care goals, but we don't talk about them, quite possibly because they are not English-speaking countries, so we are less motivated to look at their systems in detail.

This “universal” health care" costs from $30.00 to $70.00 a month. In some provinces, there is not monthly charge. ... For an additional $80.00 a month, I get the privilege to see a naturopath six times a year and 50% dental coverage. Yipee.

So if you have a job, for between $80 and $150/month, you get health insurance and dental insurance, which you can't be turned down from, and all your medical bills will be taken care of? That's a steal. Unless you can compare the situation in Canada to the situation in the USA, this isn't much of an argument.
posted by deanc at 7:01 AM on July 20, 2012 [4 favorites]


what's her name, the thing is that, to an American, that sounds like a wonderland. $30-70 for healthcare? You realize we pay about ten times that amount, at the low end?
posted by gilrain at 7:02 AM on July 20, 2012 [5 favorites]


(And that's assuming you're not rjected for the crime of, you know, needing health care.)
posted by gilrain at 7:03 AM on July 20, 2012 [4 favorites]


A form of universal health care would be great for the US.

Obamacare is a corrupt disaster which makes US health care much worse.


A lot of people who are anti-Obamacare seem to say this.

However, I suspect that any alternative put forward by the Democrats and especially Obama, would get the exact same response, regardless of how it was structured. I mean, Obama could put forward every conceivable healthcare proposal anyone could think of and the GOP would never like it, all the while saying that the US really needs a healthcare overhaul.

A form of universal health care would be great for the US. Obama-Sponsered Alternative #1 is a corrupt disaster which makes US health care much worse.

A form of universal health care would be great for the US. Obama-Sponsered Alternative #2 is a corrupt disaster which makes US health care much worse.

And so on.

I think the ACA has a lot of flaws. I think we should have just gone to single-payer from the very beginning. But it's disingenuous for the GOP to act like the flaws in the bill are what they care about when they have championed pretty much the same bill in the past. It's not that they don't like the bill. They just don't like that it's Obama's bill.
posted by triggerfinger at 7:03 AM on July 20, 2012 [4 favorites]


I can't speak to the specifics of the system you are describing, what's her name, but let me suggest that perhaps the imperfections you describe look great to those of us with the American system, thanks to the contrast with our system and your (imperfect) one. Just my two cents.
posted by lazaruslong at 7:04 AM on July 20, 2012 [1 favorite]


"The average American really does prefer to go bankrupt or see their whole family starve than to know that one of Those Lazy People got something they didn't deserve."

Despite being completely unable to pull up any relevant and reliable stats on the numbers of Those Lazy People in welfare roles. But then again, evidence has little to do with belief.
posted by Dodecadermaldenticles at 7:04 AM on July 20, 2012


side note: one of three frequently used techniques to try and stop a PSVT episode is the mammalian diving reflex, which is totally rad.
posted by lazaruslong at 7:08 AM on July 20, 2012 [2 favorites]


Then I tell them about 10 days holiday a year if you're lucky, laws which make it legal to fire someone for any reason you like with no comeback and $5,000 bills for an ambulance ride and they gaze into their cups of tea and say 'crikey'.
I don't know where you get your information about U.S. labor law, but you it's not from a lawyer. There are in fact laws around hiring/firing in the United States that give employees legal firepower to protect themselves against wrongful termination. There is no single federal statute covering wrongful termination. It varies by state. In Illinois there are a number of law firms that specifically handle wrongful termination and other labor cases.

It's true that many employers fudge the lines and try to get around paying severance pay when they need to shed some workers. On the whole the power is very much in favor of the employer, but it really does depend on the state. So to say that a U.S. employer is able to hire/fire you for no reason is generalizing quite a bit.

I live in Illinois and, having witnessed several of my colleagues get fired for various reasons, there is quite a lot of "paper trail" required to fire someone without fear of legal repercussions. You need to have a record of telling the employee they're not meeting expectations, then you have to provide them with the steps to improve their performance, et cetera. It's a funny little dance that every white-collar worker learns to identify and think "uh oh, they're trying to fire me". In my state, "at will employment" just means that you haven't signed a contract, so you are free to quit whenever you want and the employer can terminate you – but not without cause. It's such a pain to fire people, actually, that the employer will usually opt to push the employee into a powerless role where they're "out of the way" before trying to axe them completely.

Granted, this mostly applies to white-collar jobs where employees are more likely to actually know the labor laws and to be litigation trigger-happy.
posted by deathpanels at 7:15 AM on July 20, 2012 [4 favorites]


"That would be ignorance."

Yeah, I have to agree that it is more than this.

The main problem is that many people think about universal health care in terms of private, for-profit terms. It isn't just ignorance. It is really a blind-spot and a reasonable and expected response if all you have ever known is Big Coverage.
posted by clvrmnky at 7:19 AM on July 20, 2012


This “universal” health care" costs from $30.00 to $70.00 a month.

And you're complaining about that? You've got be kidding.
posted by spaltavian at 7:19 AM on July 20, 2012 [5 favorites]


"what's her name, the thing is that, to an American, that sounds like a wonderland. $30-70 for healthcare? You realize we pay about ten times that amount, at the low end?"

Yes, I have lived in the states and I am a little bit familiar with the system there and I was not trying to compare differences. I think a lot of people think that in Canada, it's all free and you get what you want - and all I'm saying, it's not like that.
As Picard’s article explains: if we seriously want to talk about health care – and design a universal system, Canada's health care system should not be the example.
posted by what's her name at 7:24 AM on July 20, 2012


In fact most other western countries use a hybrid public/private system to fulfill their universal health care goals, but we don't talk about them, quite possibly because they are not English-speaking countries, so we are less motivated to look at their systems in detail.

Exactly. We should be looking at France and Germany, which have cheaper and better health outcomes than three Anglophone systems we always talk about.

PPACA is a highly watered-down German system; if we can add public option one day the I think we'll actually be headed towards the optimal solution here.
posted by spaltavian at 7:27 AM on July 20, 2012 [2 favorites]


As frustrating as specialist waits may be, what's her name, they're not an artifact of the Canadian system. I'm in the US, and have insurance. The last specialist referral I got (for a very serious condition indeed) resulted in an appointment 3 months out. One set of tests then got scheduled a month out. A second group in another month. In both cases, purely because of scheduling, not out of medical need to wait. That's for a serious condition and I live twenty minutes from a large medical center. For something without life-threatening potential, I wouldn't set too much store by the idea of same day/next day visits to high-skill specialists in the US either.
posted by tyllwin at 7:29 AM on July 20, 2012 [4 favorites]


In addition to the higher taxes thing, the one thing that outrages most Americans more than anything is the idea that someone, somewhere is getting something they don't deserve on the taxpayer dime.

This is definitely a huge part of it, and we see it repeated over and over. Reagan's imaginary "Welfare Queen" was one woman he claimed to have met who games the system. ONE! Or the Florida initiative to drug-test welfare recipients, which spent $110,000 in 4 months to save around $60,000. But apparantly spending $40,000 in 4 months is worth it to prevent dirty pot smoking hippies from collecting benefits.

As frustrating as specialist waits may be, what's her name, they're not an artifact of the Canadian system.

Heck, getting an intake appointment with a primary care physician can take 2 months in the US, depending on where you live. It takes 3 months to schedule a non-OB appointment with my gynecologist.
posted by muddgirl at 7:37 AM on July 20, 2012 [2 favorites]


in most provinces, Canadians must pay monthly to their provincial governments monthly for health care (If you don’t, you don’t get health care and your bill will be sent to a collector).

Maybe in most provinces - but for most Canadians? 1/3 of us live in Ontario, where there is no charge whatsoever. There is an up to $600/year tax added to our provincial income taxes for health care - but that's $0 for anyone with an income under $20k, and prorated above $20k (My SO and I have never paid more than $300).

In the meantime, neither my SO or I have any benefits, and we receive excellent primary care, free specialists when we need them (all waiting lists are for procedures that can be delayed - if it's life threatening, you are seen immediately).

It sounds like you need to lobby for your province to be more like Ontario.

Or we all need to lobby to just socialize our system like the UK - I received excellent care in the UK, as good as in Canada (and better than my private coverage in the US).
posted by jb at 7:37 AM on July 20, 2012 [1 favorite]


I don't have to pay (other than high personal income tax) for my health care, but I am obliged to pay for prescription drug care, either through a company plan (which I must take if it is offered, unless I am covered by my partner's plan) or through the government plan (only available if I am not covered privately, indexed to income). All drug plans must include at least everything the government covers (ie, birth control pills must be included, so I have seen my forms specify that birth control is included in Quebec only).

That said, I can't just get whatever might make me feel better, so it's not an all-you-can-eat buffet.

I don't think our system is optimal -- Quebec, for instance, limits the number of doctors in order to have lower health costs (they don't admit this is the reason) -- but a number of people in my family have had to have emergency surgeries, my cousin had to be flown to Boston after he was born, and we never worried about the money aspect of it, which can otherwise be a huge stressor.
posted by jeather at 7:41 AM on July 20, 2012


I suspect that should Universal Health Care appear in the USA it would work very much like what they author would fear; whatever political winds were blowing at the time would sway how it would work and thus Abortion wouldn't be covered and midwifery would be some kind of fringe thing covered only the "hippy states"
posted by NiteMayr at 7:52 AM on July 20, 2012


For reference, in my employer-subsidized health insurance plan, I pay about $1,400 a year in premiums just for me. Covering my spouse would be an additional $3,300 a year. This is medical and drug coverage - it doesn't include dental or vision (which are about $20 a month each). This is also the cheapest plan my employer offers.

Private insurance isn't subsidized by anyone (although I believe they can take a tax deduction on their premiums), so is much, much more than this.
posted by muddgirl at 7:55 AM on July 20, 2012


It's $3,300 a year total for me + 1 dependent.
posted by muddgirl at 7:59 AM on July 20, 2012


it doesn't include dental or vision (which are about $20 a month each)

And just as a data point, I'd be very surprised if that dental and vision insurance paid anything like 100% of what the care actually costs. None of the plans available at my (huge) employer do, nor did the ones at my previous (huge) employer.
posted by tyllwin at 8:02 AM on July 20, 2012


...health care is government mandated in most Canadian provinces, which means we do not have the right not to have health care.

I'm sorry. I keep reading this and hearing this from various sources, but would someone explain to me why you wouldn't want health care (aside from certain religious dictates)?

Me personally, I've been uninsured for around two years now, I certianly don't view it as a freedom issue. For me, it's a low buzz of daily background panic of "What is going to happen to me today?" I've been fortunate to only get sick a few times and each time I'd have to weigh the need of going to a doctor v/s what I could afford, and I'd usually either suck it up, or in, one dire case, pay out of my savings to go to a doctor, which was a significant setback as I was unemployed at the time.

Now I finally have a job and I'm counting down the days until I can go on my employer's health plan and I already have a list of things I plan to do once I can get back to having regular (non-emergency) care, and I can stop fretting over all the accidents that could happen this afternoon and wipe me out financially. So for me, at least, I'm far more concerned about freedom from financial self-destruction than I am about this freedom to stay home and not go to a doctor.
posted by 1f2frfbf at 8:05 AM on July 20, 2012 [5 favorites]


People who focus on choice and individual responsibility fundamentally fail to understand what a civilized society is supposed to be about. It's not a giant reward mechanism for virtue. It's supposed to be an ordering mechanism. That's the basic justification for individuals yielding power to the collective - the alternative is chaos. We're better off when we create order. Well, the way you create order isn't to observe the chaos and then point out the people who survive it so that they can be applauded. You fucking build systems that create efficiency and properly incentivize individuals to behave in socially beneficial ways.

Consider this example. Society's job is not to yell at the people taking the shortcut. It's to put the path in the right place.

If people are getting sick in expensive ways because they don't do preventative care, society isn't supposed to be like "well you must not be the fittest, enjoy not surviving." Society is supposed to figure out how to make it easier to get preventative care so that people do it and everyone is better off. Collectively. In our non-jungle.
posted by prefpara at 8:17 AM on July 20, 2012 [14 favorites]


I mean, the receptionist at my NHS clinic isn't exactly what I'd call friendly, ...

Right, sure.

... but if you call up at 9 you can usually get an appointment with a doctor in the afternoon, ...

Oh cool!

... and it's free.

Nice! Uh, wait, actually, go back to what you were saying earlier?

... but if you call up at 9 you can usually get an appointment with a doctor in the afternoon, ...

WHAT?! I am blessed with a pretty good health insurance plan through my employer in the US and I have never understood the "people in countries with universal healthcare have to wait months to get an appointment" talking point, because literally every healthcare professional I have made an appointment with in my adult life has had a waiting list at least a month long. Maybe it's because I live in a city, but this still makes the whole thing feel that much more unjust.
posted by invitapriore at 8:19 AM on July 20, 2012 [6 favorites]


I'd be very surprised if that dental and vision insurance paid anything like 100% of what the care actually costs.

No, Dental is 100% of routine care and 80% of everything beyond that. Vision is pretty complex but it comes down to covering about 75% of routine exams and glasses/contacts.
posted by muddgirl at 8:21 AM on July 20, 2012


uncleozzy: " It's okay to spend tax dollars on firefighters and police and soldiers for everybody because those are in the "god-given-rights" part of the national psyche. But not healthcare."

When I was growing up, until I actually worked for a hospital when I was 20/21, I had always assumed from the age of like 5 on, that doctors were like police and firefighters, something that "The State" did. I don't know how I knew, exactly what "the state" was, or what level of cognizance of it I had, but it was important... Ambulances had lights and sirens, it was vital to safety. Doctors and nurses wear uniforms. They are important enough that people have to pull over on the road when an ambulance flashes their lights so... Clearly they are part of the government and have authority.

So then when I worked at the hospital and found out that, actually, they were private practices, that they were businesses in the game to make a profit. I was shocked. How did I go my whole life without knowing this?

And I was a capital L Libertarian then, and I think even then I was shocked and thought that it wasn't right (but I have a hard time believing I thought the state should control it, so maybe my memory is faulty, or maybe that's why I'm not a Libertarian anymore because the fertile dirt in my brain wasn't able to let that evil seed take hold).

Anyways, yeah. I wonder if you did a survey of little kids (I don't know how you would ask, maybe explain government vs private sector jobs somehow) and then ask what they think different jobs are (public/private)... I bet you'd find a lot of kids think that health care is a natural public service that is provided by the government.

I think I thought teachers were government jobs when I was real little, as well, though I'm not sure about that...
posted by symbioid at 8:22 AM on July 20, 2012 [1 favorite]


I pay about $1,400 a year in premiums just for me.

Now that's a big hit, muddgirl. And don't get me wrong, I'm not trying to get into the suffering olympics here, but...

At my employer, the family plan I chose, which is the cheaper of the 2 by 20 bucks a month, is $1200/ month. I pay more for healthcare than I do in federal income tax. I think this is crazy and irresponsible diversion of wealth. My healthcare tithe is more than many people make in a year. It's ridiculous and shameful. And this is supposedly employer-subsidized!


I'm shopping for cheaper, but the problem is that it's really hard to know what you're going to get in terms of coverage with some of these other plans. There are some high-deductible options that look good, but I have to make sure I can keep my current providers, see if dental makes sense, etc. My understanding is that ACA is going to bring some clarity and transparency to the process at least - so you will understand what you get and what it costs - but it doesn't go far enough for me. It's a fucking ridiculous waste of energy and wealth and I for one will get on the streets and party the day we get single payer in the US.
posted by Mister_A at 8:22 AM on July 20, 2012 [2 favorites]


I can only report about Canadian health care from a person living below the poverty line perspective. It has been great for me.

I've had 14 years plus of mental health care taken care of. My gp realized that he couldn't help me so referred me to the mental health clinic. I've been able to have as much therapy as I want for free. I've been able to switch therapists when I realize whatever one I am with isn't working for me.

The shrink recommended I go on disability and filled out the forms for free. He referred me to a local organization that would help me go through my appointment and advocate for me.

Medicine is covered under disability (as well as when I was on social assistance) and that means I can squeak by living on 9,000 a year.

When I attempted suicide I felt no qualms about going to the ER when I changed my mind. I ended up in the ICU and spent a week in the psych ward. All of which was covered.

My friend who has MS is able to qualify for medical help so that she can get her 1,000 dollar medicine paid for completely. As well as get sent to all manner of specialists and get her car and ferry costs reimbursed to get there. She is able to still work and not be covered by a company's plan and still take what she needs to be well.

The only problem I see with the Canadian system is lack of doctors in rural communities like mine. There are people here who have been waiting for a year plus to find a doctor. However, they can also go to the ER for free, and the new urgent care clinic for free.
posted by kanata at 8:25 AM on July 20, 2012 [4 favorites]


Mister_A - I hope I didn't give the impression that I thought I was suffering! My employer is very generous with their insurance subsidy, and in exchange my income is slightly less than competitive. I was providing a counterpoint to the number given as the increase in provincial taxes in Quebec - $600/year for a family seems like a dream.
posted by muddgirl at 8:28 AM on July 20, 2012


This “universal” health care" costs from $30.00 to $70.00 a month.

My job has me on as a long-term temp. Read: no benefits. My private insurance costs me $183 a month. Realize that $183 covers only me, and I have no dependents. If you have a spouse and kids, the number balloons to $600 instantly. Also, that's after-tax money, not before-tax. I personally can't even write the insurance off because of the US tax code (I have to spend 7.5% of my income on healthcare before I see any deductions). For my $2,200 I spend per year, I get medical and vision, but not dental. I have two wisdom teeth that need pulling and a cracked tooth that needs a crown, except I can't spare several thousand for it. I'm pushing it all off until either they start to hurt or I get dental insurance, whichever comes first. Last year I wound up in the hospital after three ER visits (a staph infection in my face, two days in the hospital to get antibiotics and one ultrasound). It cost me $4,000 AFTER insurance.

Most reasonable Americans are aware that UHC isn't free. But please get it through your head that we are paying through the nose for healthcare. The $70/month plus the additional $80/month you mentioned for extended benefits would still be cheaper to start with and I wouldn't have to make months of payments to pay off a short hospital stay.
posted by Mister Fabulous at 8:36 AM on July 20, 2012 [6 favorites]


There is an up to $600/year tax added to our provincial income taxes for health care - but that's $0 for anyone with an income under $20k, and prorated above $20k (My SO and I have never paid more than $300).

All I know is, in the US I'm getting coverage for my family that is heavily subsidized by my company, and so I only pay a tiny fraction of what my employer pays for that coverage, plus it is very good coverage that my friends are envious over...and I'm paying more than $3,000 a year for it.

So, my younger, broke self, who would have paid nothing for health insurance in Canada as you describe it, is jealous...and so is my current self, who could pay four times your yearly maximum tax for health care and still come out ahead of what I'm paying now. Amazing.
posted by davejay at 8:45 AM on July 20, 2012


of course, I'm still thrilled as punch to have my current health care as subsidized as it is -- hooray for my company -- so I'm not complaining much here...it could be so very very much worse.
posted by davejay at 8:46 AM on July 20, 2012


I always get unnerved by these starry-eyed news articles about Canada’s so-called glorious health care system. This is NOT Universal Health Care. This is NOT a system to be admired.

It has its flaws, sure. Universal is the term used to describe the breadth of population covered (and even with that, there are some problems at times), not the scope of services offered - some procedures are considered optional and out of pocket, and other professional services such as dentists and optometrists aren't covered. I would love to see it expanded to include more, but I'm never going to say it's a system we should dismantle, because of my own experiences with it

This is a story I'm going to start beating into the earth soon, but I'll tell it again:

In November of 2010, my son came down with a horrible case of Strep A pneumonia (apparently, the strep bacteria is not one you ever want in your lungs). He spent 15 days in the hospital, half of that time in intensive care following surgery to relieve the fluid build up around his lungs. Once he was in intensive care, the docs there described him as the sickest kid on the ward. I could fill half a page with the emotional, physical, and psychological toll those 15 days took on our family.

But we never, ever had to consider the financial costs. Every procedure, test, and drug we discussed with our doctors - and we had a host of them: interns, residents, infectious disease, surgeons, even department heads (not the mention the fantastic nursing staff) - was about the benefits and risks and how they fit as a part of an overall treatment strategy. When I took my son home that last day, I was out of pocket on three things: parking; meals; and the cost of his prescription for the antibiotics he still needed. My health plan at work covered those about a week later.

Without our health care system (and in Alberta, we no longer see our direct monthly fee, but as I recall we were paying about $140/month as a family), we would have left that hospital tens of thousands of dollars in debt. We still wouldn't be "recovered" from that illness.

It ain't perfect, but don't let perfect be the enemy of the good.
posted by never used baby shoes at 8:48 AM on July 20, 2012 [10 favorites]


So hey! Last night I had a heart attack scare. Chest pains, crushing sensation, agony. I went to the hospital here and got taken care of tout de suite. Buncha tests, chest X-ray, chest shaved by pretty nurse, the whole nine yards. Turned out to be a major esophageal spasm, which was the result of previously undiagnosed asymptomatic something-or-other to do with a valve in the top of my stomach. Here's your prescription, do you need a ride home, have a good evening and it was good that you came in.

Total cost to me: sweet fuck all other than my monthly BC medical payment of zero dollars because I work for an employer who thinks that even that minor cost is something I shouldn't have to bear. If I was unemployed or underemployed my monthly BC medical bill would be partially or wholly subsidized. Payments cap out at 128 bucks a month for a family of three or more. A single person pays a max of sixty bucks a month for BC Medical. Fair Pharmacare also assists in paying for prescription costs, but my employer has extended medical that pays for those too.

If I was completely unemployed, I would receive the exact same care in the exact same timeframe, and would have 70% of my prescription costs covered. Once I had paid a max of $25 a year in prescription costs, Fair Pharmacare would cover 100% of my eligible prescription costs.

I told an American friend about my evening and they were shocked that I would be so willing to go to the emergency room for something that turned out to be nothing. I can't imagine living like that. Good God, I am not a doctor! How the hell would I know what is or is not a major emergency?

BC Medical is fucking awesome and I was insanely glad to live somewhere that when I am concerned about a medical emergency I can just go to the goddam emergency room without worrying about bills or whether my insurance was going to try to fuck me or whatever. Why the hell would anyone want to opt out of this? Fuck some nebulous idea of "rights", I want healthcare when I need it and not when I can afford it or when it's so damn serious I can't ignore it.

From my point of view everyone should have the right to healthcare provided to them simply by dint of living in civilization. Sure there are flaws and the system could be better, but when I look south to the US, I realize that it could be so much worse. My heart goes out to every American for whom healthcare is an impediment to quality of life. That's just not how it's supposed to be.
posted by Sternmeyer at 8:57 AM on July 20, 2012 [8 favorites]


WHAT?! I am blessed with a pretty good health insurance plan through my employer in the US and I have never understood the "people in countries with universal healthcare have to wait months to get an appointment" talking point, because literally every healthcare professional I have made an appointment with in my adult life has had a waiting list at least a month long. Maybe it's because I live in a city, but this still makes the whole thing feel that much more unjust.
Sometimes waiting lists can be quite long, but that is where the secret of keeping costs low comes in. My mother had a hysterectomy late last year, and had to wait a few months, and then a few more because somebody bumped her off the list. But she didn't wait because she was poor, but rather her case was low level. She didn't have a malign tumor, and wasn't in great pain. To make the most of the surgeon he has a full workload, so there can be waits to have the surgery done. He makes an assessment according to medical need and schedules you accordingly. That's why my mother was bumped by another patient. She was a little angry about it at first, but we know that they reason somebody jumped ahead of her is because they're in a much more dire position.

So yeah, she had to wait a few months, but she's still alive today, and the person who got rushed in may well be dead. But the costs are low, the care decent to good, and folk are handled according to their need. I guess that most "months long waits" are due to folk being low on the list for a non-emergency treatment, and not those in harm's way being left to die.
posted by Jehan at 8:58 AM on July 20, 2012 [4 favorites]


but there's a shockingly large contingent of people who honestly believe, or at least want to believe...that you have to wait for weeks or months to get an appointment...

Well, that part is largely true. While you can get in to see somebody without a huge wait (thanks to walk-in clinics), seeing your family doctor (if you're lucky enough to have one) does take weeks, an referrals to specialists routinely take months.
posted by one more dead town's last parade at 8:58 AM on July 20, 2012


Going to the emergency room, on my insurance, costs $100 copay. I haven't even looked into what a stay costs.

seeing your family doctor (if you're lucky enough to have one) does take weeks, and referrals to specialists routinely take months.

Yes, just like in the US.
posted by muddgirl at 9:00 AM on July 20, 2012 [1 favorite]


Good god. My employer pays two thirds of my insurance premiums. I personally pay $180 a month. And my premiums will be going up by 10 percent next year. I have no deductible, which is nice, but I have to pay a $15 copay for every office visit and the same amount for prescriptions. And I feel DAMN LUCKY to have the insurance that I do, even with the long waits to get in to see a doctor. My brain would explode if I only paid $30-70 a month for coverage.

Additionally I pay $20 a month for dental coverage of $2000 a year. But I also have to pay 25%. Preventative and diagnostic stuff is free.
posted by elsietheeel at 9:01 AM on July 20, 2012


Yes, just like in the US.

A little slower, actually. But at least there's nothing out of pocket and you won't lose your house to medical bills.
posted by one more dead town's last parade at 9:04 AM on July 20, 2012


Exactly. We should be looking at France and Germany, which have cheaper and better health outcomes than three Anglophone systems we always talk about.

Yeah, but, they really are quite different, France has a truly national service, Germany has... I wouldn't know what to call it myself, I guess hybrid by approximation, but it is very different from the French and UK systems which are tax-based services - the German system is based on the principle of insurance.

There are several main public - state-owned - insurance companies and then a whole lot of private ones; the way it works, if you're working, your employer will pay half the benefits and the other half will be deducted as a contribution from your income, and you can choose with state insurer you want. If you are unemployed, you sign up with the relevant services to get unemployment benefits (not as easy and generous as they used to be once) and they cover your healthcare for you. If you are a freelancer or entrepeneur, you get your own insurance and pay all of it yourself, and it's proportional - usually 14% - but starting from a fixed minimum which is not really cheap and can be a significant chunk if your income is modest.

In practice, it works almost like a full-on nationalised services, public insurers cover a huge lot of things, more than in other countries - they will even pay for a "Kur" ie. in practice a full spa treatment holiday, including for your child if your doctor recommends it - and you get really great treatment. But if you belong to a category that has trouble getting insured, or are temporarily without a job and without benefits (including non-EU foreigners for instance), well you're out. It's not truly universal.

I got billed for an ambulance and hospital stay and surgery after an accident *in Germany* - luckily I still was covered by universal state healthcare in my native country and because it's valid EU-wide I just passed on the bills and it was taken care of. But the shock of getting a bill for an ambulance and emergency hospitalisation and surgery is not even something I expected within the EU. That's how I learnt the German system is not really "public" in the way you think about it in the UK or France (or Italy as was my case). I wouldn't have gotten any damn bills in the first place in those countries. I could have been an illegal non-EU immigrant and still gotten free treatment there.

So yeah please use the UK or France instead of Germany as a model to refer to. Just my two eurocents.
posted by bitteschoen at 9:07 AM on July 20, 2012 [4 favorites]


I'm in Ontario. I don't even have a family Doctor. I just go to any walk in clinic when I have an issue. Longest wait I've ever had is about 1.5 hours.

I do tend to go to the same walk-in Doctor when I can because he's great, usually spot on with the diagnosis, and explains everything in a great way. Since I'm freelance and don't have a drug plan, when he can, he just gives me a box of samples for medication.

I know that this coverage is not "free" because my taxes, along with the taxes everyone else pays in this country, pays for these services. I'm totally comfortable with that.
posted by juiceCake at 9:09 AM on July 20, 2012


Uhm sorry to be clearer by "category that has trouble getting insured" I didn't mean the way Americans think of it, there is no criteria such as pre-existing conditions, at least not for public insurers, but I meant, all those people who are temporarily not covered or for whom coverage would be too expensive (like, yeah, hello, us freelancers not making a lot of money).

Because it really is considered a form of insurance and that makes a world of difference.

(Personally I don't care if the total amount ends up being similar, it can happen that in both systems you end up paying almost the same but really I prefer a tax-based proportional approach that caters to everybody in every phase of their life, to this stupid idea that healthcare should be a matter of personal 'insurance'.)
posted by bitteschoen at 9:14 AM on July 20, 2012


And, in most provinces, Canadians must pay monthly to their provincial governments monthly for health care (If you don’t, you don’t get health care and your bill will be sent to a collector).

At least in B.C. this is wrong. You won't be denied health care even if you haven't been paying your premiums. From the Medical Services Plan website:
Note: MSP coverage is not cancelled when a person's premiums are in arrears. Cancellation only occurs if a person ceases to be a resident of B.C. or there is concern that the individual may no longer be a resident.
I don't know about other provinces but I'd be surprised if it was different anywhere else.

I'd also be curious to see some information about these "free" clinics that are supposed to be appearing in our major cities. How are they different from any other walk-in clinic? When I go to one of those I don't pay anything either. Are you talking about free dental clinics, what's her name?
posted by fansler at 10:02 AM on July 20, 2012 [1 favorite]


The whole 'socialism wah!' explanation doesn't really explain much to me, so could someone break it down for me and tell me why it's such a bone of contention?

Health insurance is typically a benefit provided by employers. People believe that the only people without health insurance are the unemployed, that is, people who are too lazy to work.
posted by Wordwoman at 10:05 AM on July 20, 2012 [1 favorite]


I always get unnerved by these starry-eyed news articles about Canada’s so-called glorious health care system. This is NOT Universal Health Care. This is NOT a system to be admired.

I think it depends on what province you are in. I've lived in BC for the past 8 years, and have never had any problems with the medical system. We've had a kid here (the maternity ward was fairly utilitarian), and have had many trips to the emergency ward with both my wife and our two sons.

I've also had to see a neurologist to rule out a fairly serious and terminal illness, and that was fine too.

Digging a little deeper, there are serious structural issues with the health care system, notably with the cost of new technologies and therapies, and how those technologies and therapies are used to prolong the life of an increasingly aged population, no matter how poor the quality of life (my grandmother, for example, was technically dead after a stroke at the age of 90, but was resuscitated to go on to live another 4 years with limited ability to function; she rapidly declined into senile dementia).

It's not a perfect system, but it works quite well in British Columbia.
posted by KokuRyu at 10:11 AM on July 20, 2012


we never, ever had to consider the financial costs. Every procedure, test, and drug we discussed with our doctors - and we had a host of them: interns, residents, infectious disease, surgeons, even department heads (not the mention the fantastic nursing staff) - was about the benefits and risks and how they fit as a part of an overall treatment strategy.

Echoing this, also based on intimate firsthand experience with the (flawed but still very good) Alberta health care system.

My second child was born with a great whack of complications (he has a very rare chromosomal deletion) and spent his first few weeks in intensive care, undergoing every diagnostic test there is. Each day, when the supervising doctor on the ward came by for rounds, we'd have a short discussion of how he was doing and what we would try next. The only thing that mattered was our son's health and the potential effectiveness of the treatment.

(In the style of a premature baby - which he wasn't - he eventually just started functioning well enough on his own and was released; diagnosis - by a geneticist we saw repeatedly, at his and our discretion, for free, same as the cardiologist and therapists and everyone else - came several months later. He's a thriving little kid now, though delayed.)

Anyway, a couple months after the ICU ordeal, I was down in New York for work and had dinner with some friends. They are classic Upper West Siders - Columbia PhDs, NPR listeners, world travelers. The kind of couple who literally do not look at apartment listings in other parts of Manhattan (let alone other boroughs) when they have to move. Very liberal, hyper-educated, worldly, all that.

So I come to the end of my little retelling of our son's rocky start, and they've got their first on the way so they're more attuned to this stuff than most. They have one question. Which was: "So when he was getting all this stuff done, you didn't have to consider cost at all?"

To which I replied of course not. And even though they know the score on both sides of the border and so do I, they were incredulous to learn that in the Canadian system cost literally plays no role in urgent care, and I was equally incredulous at a kind of gut level that such questions could possibly be part of a conversation with a doctor at the bedside in a neonatal intensive care unit in a wealthy country. The distance between our respective incredulities is the distance between American health care and that of the rest of the First World.
posted by gompa at 10:34 AM on July 20, 2012 [4 favorites]


When I first moved to Germany, I avoided going to the doctor because I had been financially punished by the US system so severely that I dreaded seeking care. When potential blindness forced me to finally seek help, I was enlightened.

Universal healthcare is the best method of providing and paying for healthcare in the general population. There are many examples of its success in the developed world.

Embrace it, America.
posted by moonbiter at 10:42 AM on July 20, 2012 [1 favorite]


I don't know what province "Whats her name" lives in but I live in Alberta and until awhile ago (6 yrs?) Albertans had to pay a certain amount per year for heath care. It was around $40.00 buck every quarter I don't remember anymore. I know from personal experience that you still had access to health care even if, you DID NOT pay. The health care professionals providing the care didn't know your billing status and didn't refuse you service when you asked about the issue. Yes, you got sent to a collection agency who phoned and sent letters until you paid the balance.

I go to my doctor (usually takes a couple of days to get in), or the walk-in clinic (2-4hr wait) or the emergency room (that wait time depends on the injury, an almost severed hand resulted in immediate service) where I go depends on how urgently I require medical care and happily none of this costs money. At the walk-in clinic I time my visits to when the doctor I prefer is on rotation but all of the doctors there are fine and I usually have my choice of 2 doctors. The only downside to the walk-in clinic is the wait time and sometimes I wonder to myself is this issue worth the 2-3 hrs wait for a prescription or will it clear up on it's own. Money is never a factor.

It is difficult to find a doctor you like that is accepting new patients and wait times to see a specialist can be months and months. However, how fast you see a specialist also depends on how serious your case is. You might wait months to see a specialist or be in in a couple of days if your referrring doctor thinks it's that urgent.

Our friend went to see an optometrist because he was experiencing vision problem. The optometrist told him to see his doctor immediately, which he did and his doctor immediately had him in to see a specialists who immediately scheduled him for a scan the next day and within a few days of the scan he was in the hospital having a brain tumor removed.

Only the optometrist visit cost any money.
posted by Gwynarra at 11:03 AM on July 20, 2012 [1 favorite]


This stuff is ridiculous:

And, in most provinces, Canadians must pay monthly to their provincial governments monthly for health care (If you don’t, you don’t get health care and your bill will be sent to a collector).

Untrue. For example, in BC, a) the monthly cost is reduced if you make less than $30K and $0 if you make less than $22K, b) you will eventually have to pay, but you will still receive medical care if you aren't paying (technically, you can opt-out, but that's not what happens if you don't pay and I've never heard of anyone actually doing this).

And even if you pay - your health care is extremely restricted. In B.C., on basic care, I can see a primary physician and the referrals given or testing that is covered under the medical health system (minimal options).

You see a primary care physician and they can refer you to specialists, order tests, etc. I'm not sure how this is "extremely restricted".

I know many people who do not have health care because they cannot afford it. More and more, free clinics are appearing in our major cities.

I really doubt these people exist. Who are they? Where do they live? Why can't they afford the very minimal cost? I have no idea what these supposed free clinics are. If they are so poor, why don't they receive lower or zero premiums?

Honestly, I doubt that you actually live in Canada because your comment really doesn't reflect the reality on the ground here.
posted by ssg at 11:05 AM on July 20, 2012 [14 favorites]


my current health care as subsidized as it is -- hooray for my company

It's not subsidized by your company. You are earning all of the cost. The part "paid by the company" is tax-free, that's all. The line between what 'the company" pays and "you" pay can be anywhere from 0% to 100%. It is only an accounting trick.

Obamacare doesn't change this at all. The tax accounting trick (fraud) remains in place as before, you think your company is subsidizing you when it is not, and Obamacare ties health insurance even more tightly to employment - tying you to your company.

Removing this tax trick - removing the laws that allow this existing tax trick, not adding 500 more pages of regulations - should have been the very first step of changing and improving US health care, lowering insurance prices to everyone in the country. This could have been accomplished with one of Obama's executive orders literally instantly and overnight.

But no.
posted by caclwmr4 at 11:40 AM on July 20, 2012


I have had two surgeries on my hand. One was an emergency; for bizarre reasons I had to wait one day for the surgery. The next surgery, to fix the problems still left over, was elective (ish -- it was medically indicated, so I didn't have to pay, but if I hadn't wanted it I wouldn't have died, just been in a bit more pain and had a bit less function in my hand). So I had to wait until it could be slotted in at a hospital. It took a while: I went to my GP, who referred me to a plastic surgeon, who referred me to the second surgeon (about 3 months each time), and then we had to time the surgery based on OR time and "please not until the school year is over in April", but I still got that (entirely optional on my part, zero urgency) surgery in the first half of May, less than a year after I started the process and including a 4 month wait that I caused.

When I went to a clinic while I was in school in the US, OTOH, every time I tried to go to the clinic they refused to treat me until I took a pregnancy test.
posted by jeather at 11:59 AM on July 20, 2012 [1 favorite]


Removing this tax trick - removing the laws that allow this existing tax trick, not adding 500 more pages of regulations - should have been the very first step of changing and improving US health care, lowering insurance prices to everyone in the country.

What? It just would have resulted in a spike in everyone's tax bill. But some people think there is a magical-fantasy-ponyland where eliminating the tax deduction (which will fade out starting in 2018 or something) will magically cause people to start negotiating with their insurance companies for a better rate like they were haggling over a car.
posted by deanc at 12:15 PM on July 20, 2012 [2 favorites]


When I went to a clinic while I was in school in the US, OTOH, every time I tried to go to the clinic they refused to treat me until I took a pregnancy test.

I tried explaining that habit to my British friends and they were extremely incredulous. Then I tried explaining to my American friends back home that I'd popped into see my NHS doctor (same day!) for some weird recurring thing and they didn't even have a billing office. Difficult to judge whose faces were more hilarious, really. No pregnancy test! No bills! What a world!
posted by jetlagaddict at 12:24 PM on July 20, 2012 [1 favorite]


Would I like to pay more in taxes to get access to some fucking healthcare? Yes please.

No, I don't want to pay more in taxes. I want everyone's fucking healthcare paid out of the tax money already paid out to the assholes in Washington who give it in subsidies to oil companies and use to wage war around the world.
posted by BlueHorse at 12:36 PM on July 20, 2012 [1 favorite]


I live in Toronto, Ontario. I've never paid for healthcare in the sense that Americans talk about. I've never paid for it in sense that what's her name talks about either.

I'm one of those people who doesn't go to the doctor unless I have to--not because of cost, of course, but just because I don't enjoy it and I prefer to think I'm going to be fine. If I'm not vomiting without reason or something isn't broken, I prefer to wait it out and let it pass.

As a result, when I do go to the doctor, it's because I'm on my last legs. This means I usually need to be seen sooner rather than later. I make the appointment the same way I do for a haircut: "Hey, just wondering if there's any time to see me today." I can only think of one time that the Doctor's office pushed me to the next day and that was after graciously offering to see me after-hours. It is harder to get a haircut appointment. And my doctor is excellent.

As for emergency rooms, I've broken my wrist, elbow, knees (different times), fingers (multiple times), ribs (multiple times), and one leg. No charges for anything, always done within a few hours of visiting the emergency room.

For various issues, I've had multiple ultrasounds, x-rays, casts, EKGs, etc. etc. Never paid a cent. Ultrasounds can be done same day or within a few depending on severity. X-Rays and casts done on the spot.

The only thing that I pay for regarding healthcare: dental work (though my dentist discounts the non-insured by 20% (insurance is usually through a job)), eyeglasses (and eye tests), and prescriptions--though if it's something common my doctor will often have samples he gives me.

In addition, I was raised by a single mother of three. One of my siblings was handicapped with a heart condition. My mother was a janitor. Without OHIP (our healthcare), well... I can't really imagine it.

So I'll stand as a counter to what's her name. Healthcare, for me, has been stellar--and free--my entire life. I cannot picture a better system and have absolutely zero complaints.
posted by dobbs at 12:37 PM on July 20, 2012


The stories in this thread have made me even more thankful to have grown up with the NHS.
posted by knapah at 1:36 PM on July 20, 2012 [1 favorite]


BlueHorse: "Would I like to pay more in taxes to get access to some fucking healthcare? Yes please.

No, I don't want to pay more in taxes. I want everyone's fucking healthcare paid out of the tax money already paid out to the assholes in Washington who give it in subsidies to oil companies and use to wage war around the world.


I see your point.

Until such time as you figure out a way to deconstruct the military industrial complex in the US and reallocate funding from war to social programs (I support you fully, though I am not optimistic about your chances) it'd be just lovely if we could fund healthcare through a new tax, instead of a pipe dream. It's just our lives we're talking about, after all.
posted by lazaruslong at 1:48 PM on July 20, 2012 [1 favorite]


For those outside of the US who can't understand why our healthcare system is the way it is, here's the explanation:

The health insurance system is not designed to deliver health care. It is designed to give employers more power over employees. It is designed to instill fear in employees, so they can be paid less for more work. "Oh, you want more money? How about I pay you the same amount of money and let you live, instead?" "Oh, you want to quit and start your own business? Good luck getting a doctor to treat your kid!" It's not about health, it's about control. And for that purpose, it works very, very well. The problem is, it has been too successful. It has eaten a large part of the economy, and is now starting to cost the employers too much money. They saw it is as way to control their employees, but now it has started to control them, too. And branding this social control as "freedom" is one of the great successes of the propaganda machine.
posted by vibrotronica at 1:52 PM on July 20, 2012 [11 favorites]


I don't think you can place the blame for our healthcare squarely on employers. That's pretty fucking absurd. My employer would LOVE to offer healthcare, we simply cannot afford it. There's a lot of reasons our healthcare is shit, and the for-profit nature of insurance companies is a big factor too.

Folks outside the states, there's more nuance to it than "EMPLOYERS ARE ALL EVIL!!!11!".
posted by lazaruslong at 1:54 PM on July 20, 2012


The original insurance plans were actually instituted by employers in a short labor market who wanted to offer an extra benefit above and beyond salary.

I have to hope that most employers recognize that truly national health care system would mean an incredible boost to their bottom line. The only industry really hurt by a nationalized health care system are insurance companies, which is why we've jury-rigged a system that still keeps them in the loop, in exchange for tighter regulations.
posted by muddgirl at 2:02 PM on July 20, 2012 [1 favorite]


I guess that most "months long waits" are due to folk being low on the list for a non-emergency treatment, and not those in harm's way being left to die.

When I needed to see a specialist or risk permanent eye-damage, I was in a specialist's office that afternoon.

The waiting lists are largely procedures like hip or knee replacements, which can improve quality of life but aren't time sensitive. We also have a shortage of orthopaedic surgeons in Canada, no thanks to US facilities offering more money.

though, frankly, I think that any doctor who trained in Canada is a bloody traitor if they move to the US for more money - we subsidized their education and they owe it to their country to stay here.
posted by jb at 2:17 PM on July 20, 2012 [1 favorite]


I live in BC. My wife and I pay $116 a month for the two of us for Medical Services Plan. That premium has gone up twice in a short time as the result of an inept government. That's part of our medical coverage; the other part is HOSP -- BC hospitalization. HOSP is funded out of general revenue and every BC resident is covered (there is a residency time requirement, six months, I think). If anyone can't afford MSP, then they can still walk into any hospital and receive free treatment, though I think the hospital would try to get that person free MSP. I have never had to wait for treatment. I go to the doctor I choose (I haven't been in years, so I'll have to make a choice if I get sick). My wife has her regular doctor and gets an annual checkup/pap smear. She also gets a mammogram whenever the mobile unit visits our small town, at least once a year. Over the years we have used the system for two births, one vasectomy, one appendectomy, two cancer scares (one involving surgery) that turned out to be nothing, plus emergency room treatment for wounds suffered from a fall and during a softball game. There's probably minor stuff I've forgotten. Our MSP premium was picked up over the years by several employers and dental/eye services were also offered; this is commonplace as a hiring incentive. During the debate over Obamacare, I was involved in several e-mail exchanges with Americans trying to correct their wrong impressions of the Canadian system. They refused to believe me, especially when I said that I could go to any doctor I wanted. I am an old guy and I recall full page ads in American magazines like the Saturday Evening Post back in the 1950s attacking socialized medicine. (I read somewhere that Truman tried to get it through and almost succeeded circa 1950; the ads I saw were rear guard mopping up actions -- the war had been won.) These ads were purchased by the American Medical Association. I think Americans are caught up in a strange web of beliefs full of cognitive dissonance; I also think they are unwilling to examine this belief system.
posted by CCBC at 2:31 PM on July 20, 2012


Fun story on reddit about not going to the hospital:
Last summer I was in the middle of a break up and felt super stressed, so I decided to go for a run even though it was getting pretty dark out. Someone left out some barbed wire in the alley, and I fucking slashed my ankle BAD. When I got back to my apartment my shoe was completely filled with blood, and I had 3 cuts about 2-3 inches long, completely splitting my skin so I could see the muscle or fat (I'm not sure, it was pretty gnarly) underneath. Because I was already in an emotional, Idon'tgiveafuckingfuck mood, and I couldn't afford an emergency room visit (yes, I live in the states), I super glued all of the cuts back together. Much glue was used. I then wrapped my ankle up with a piece of cloth. Over the next week and a half the glue would come apart, and the cuts would be instantly back open, due to the size. I'd pour peroxide on it and glue them back together again. Some of the pieces of cloth would get glued into the cuts. My ankle was a big crusty mess of dried super glue, blood, and bits of stained cloth for two weeks. SOMEHOW they did not get infected, and healed up alright. I have no idea why I did that or let it get the way it was, and obviously won't do it again. If I would have gotten stitches, the scars would be less noticeable, but at least I didn't have to pay $3,000?
The sad thing is that I can totally identify. I will never forget my visit to the ER and the surprise super-fun bill I got afterwards that I never thought I'd pay off. I thought I was going to move to another country to escape it. I was free-lancing at the time and hit a string of luck with jobs and money, but I'll never forget the fear I lived in. And how I vowed I would rather die than go to an ER ever again, which seems a bit immature, but I was dealing with some serious anxiety issues. And in many ways I still am. I still get immense amounts of fear opening anything from a doctor or the insurance company. Lately I got a surprise bill even though I have health insurance because a doctor did something classified as a "surgical" procedure on a routine visit...pretty much without my consent.
posted by melissam at 2:39 PM on July 20, 2012 [1 favorite]


melissam - have you called your doctor and complained? (I understand doctor anxiety makes this difficult) Dr's offices often bill things wrong, or they can change the code if they thought it was covered but wasn't. I have argued to have a doctor (actually a dentist) waive the fee because they explicitely told me it would be covered, but wasn't.
posted by muddgirl at 2:46 PM on July 20, 2012


melissam - have you called your doctor and complained? (I understand doctor anxiety makes this difficult) Dr's offices often bill things wrong, or they can change the code if they thought it was covered but wasn't. I have argued to have a doctor (actually a dentist) waive the fee because they explicitely told me it would be covered, but wasn't.

The whole thing is a nightmare. The doctor barely spoke English. She misdiagnosed me. I called the insurance company and was referred to the fraud division (since the procedure was likely not even performed based on my interview with them). So it's in limbo there. It's so much fun to go to a doctor and never know what the damage will be to your finances. It's like roulette.
posted by melissam at 2:50 PM on July 20, 2012


:( Yeah, for various reasons my partner has, basically, emergency insurance with a bit of preventative care, and a simple question like "How much is that doctor's visit going to cost us?" is like an Abbot and Costello bit. "Well, it's 25 for the copay, and 25 for the exam." "So it's $50?" "No, it's $35.25 because I prepayed a certain percent as part of my deductible, but they're going to bill me next month for the x-rays." etc. etc.
posted by muddgirl at 2:56 PM on July 20, 2012


I heard of inheritances being left even amongst the middle classes. Something I had only heard about in wealthy families in the USA.

o_0
posted by Kevin Street at 2:58 PM on July 20, 2012


I'm as big a fan of a more rational healthcare system as anyone here. In fairness, though, it's overstating the case to label the entire US healthcare system as totally failing and terrible. It largely fails the poor, and costs us all a ridiculous amount, and delivers poor aggregate outcomes for that high cost. But if you are in the quite large category of having decent insurance and enough money to pay the deductible, your access to care is going to be pretty good. Would I rather have a French-style system? Yes, absolutely, but largely for reasons of equity and because tying health care to employment is inane; my own personal health care access is already reasonable.

Here's what decent (but far from Congressional-level) healthcare access looks like in the US: My job covers my insurance at 100% and I can cover a dependent for about $2k or $3k per year; I don't remember the exact details, but it's the usual sort of package where coverage is partial until the deductible (about $1000, I think) is reached and then comprehensive after that. Dental and vision are included, as are a surprisingly large array of "alternative" options like acupuncture and massage.

I can see a random doctor on the spot at a walk-in clinic, or my regular doctor within a few weeks by appointment or the same day if there is a cancellation. We have needed a series of specialists and expensive medications over the last year or two, and getting appointments with the specialists has been a lot easier than I expected -- a few weeks out for routine stuff, same-day for urgent issues. And to my surprise the billing and insurance has been transparent and seamless, almost entirely handled between the insurance company and the doctor's office.

Again, it's a crazy system -- why does the doctor's office need a huge staff of people just to deal with insurance billing? What on earth does my job have to do with my access to health care? But it also explains part of why it is so hard to sell the idea of single-payer healthcare -- for a very large percentage of the population (mostly the same people who vote), access is currently pretty good, and it is easy for them to imagine that access worsening rather than improving if the system is drastically changed.

The biggest gain under a better system for someone like me (aside from the benefits of living in a country with better overall healthcare, of course) would be the decoupling of healthcare and employment. It would mean that I could make decisions about staying in my job or starting a small business without having to think through the implications for my insurance. That would be huge. And it's frankly immoral that so many people have such limited access to something that should be a basic human right.
posted by Forktine at 3:04 PM on July 20, 2012 [2 favorites]


I think this is the same author, previously on the Blue, of a former Quiverfull mom whose partner came out as transgender. Looks like she's having realizations all over the place.

I'm just surprised she was still a conservative Republican after that.
posted by supercres at 3:11 PM on July 20, 2012


Here's what decent (but far from Congressional-level) healthcare access looks like in the US: My job covers my insurance at 100%

Covering 100% of health insurance premiums is unusual.
posted by muddgirl at 3:23 PM on July 20, 2012


It appears this subject has not yet been mentioned, so I will bring it up.

The first true publicly-funded universal medical care scheme in Canada was established in Saskatchewan in 1962 by the democratic socialist CCF government of Woodrow Lloyd, although it had been initiated by Tommy Douglas, that party's previous leader. In response, most doctors (90%) went on strike. The doctors, with the backing of the American Medical Association, had adamantly opposed socialized medicine, the AMA being clearly concerned that if it was established in Canada, the USA might well follow that lead.

The strike lasted for more than 3 weeks. To fill the gap, the people of Saskatchewan set up their own community health clinics, often funded by the citizens themselves and manned by strike-breaking doctors supplemented by NHS doctors from the UK. As you might imagine, this was a terrifying time for the citizenry, the media joined with the doctors, and the once-popular government lost massive amounts of support.

Shortly after the doctors and the government reached a negotiated settlement, the CCF was turfed out in a general election, largely because it had brought in what we now know in Canada as Medicare. Nevertheless, the program proved so popular that the new Liberal government could not get rid of it. Within 10 years, all provinces in the country had similar universal health care schemes, and the federal government had introduced substantial funding, giving them leverage to insist on country-wide standards of care.

The point of this story is this: that sometimes to implement good public policy, you have to fight. You must fight tooth and nail, and you must sometimes take some serious punishment.

With the greatest respect to my pro-Obama friends, this seems to have been a test that Mr Obama seriously failed in his first term. Barack Obama is, as I understand it, a consummate organizer at the community level. Why did he not use those skills to build support for a truly government-run, single-payer universal system? I understand that this is what most people actually wanted, but Obama seems to have capitulated in the face of strong pressure from the right. It was a terrible mistake, from where I sit. He passed up a superb opportunity to contribute a program to his people that the country greatly needs. In doing so, he also gave up the chance to be one of the USA's greatest leaders.
posted by dmayhood at 3:44 PM on July 20, 2012 [6 favorites]


Covering 100% of health insurance premiums is unusual.

That link seemed to be giving numbers for "family coverage" that are close to what I would pay; the only mention I saw of individual coverage was an average of about $900/year cost. That's probably about what I'd pay if my employer cut it to a 90% coverage, I'd guess. I couldn't easily find a figure for what proportion of employers cover at the 100% level; the $900 average probably includes a lot of full coverage places, but also a lot of places with incredibly crappy coverage.
posted by Forktine at 3:47 PM on July 20, 2012


I would assume that nationally it's a normal distribution around the average.

I would also assume that employers who have more-skilled / better-paying jobs offer better coverage, because health insurance is a commodity that employers offer to attract employees. Employers who have mostly low-skilled jobs, or who can segment their job markets, wouldn't have that problem. Meaning that the people with the best health plans are the people that need it the least.
posted by muddgirl at 3:51 PM on July 20, 2012


Not to derail, but your example shows why the Democrats won't go to the wall for single payer, dmayhood. The CCF did the right thing, then they fought to keep their achievement alive and won - and lost the next election. People value Medicare now, but that didn't help the pioneers who first implemented it. No politician wants to be a noble sacrifice, they'd prefer to win and keep winning all the time.
posted by Kevin Street at 3:57 PM on July 20, 2012


When I went to a clinic while I was in school in the US, OTOH, every time I tried to go to the clinic they refused to treat me until I took a pregnancy test.

I don't understand. Why would they do that?
posted by antiwiggle at 3:57 PM on July 20, 2012 [1 favorite]


But this is all beside the point - I think even Americans with gold-plated insurance plans can understand that, despite how awesome we are at life, Americans pay more for every procedure that we get, compared to countries with more nationalized plans of any type. As I said before, the amount I pay for insurance premiums is not a huge hit to my budget - it's definitely less than I spend at restaurants or even on alcohol in a year. But I still support decoupling cheap health care from employment status, because I recognize that we have a duty to care for citizens that aren't in the same position as I am.
posted by muddgirl at 3:58 PM on July 20, 2012 [1 favorite]


Why would they do that?

Liability. If it turns out you are pregnant and didn't know it they are plausibly liable for any treatment they gave you that might lead to a negative outcome for the fetus.
posted by JPD at 4:10 PM on July 20, 2012 [1 favorite]


But this is all beside the point - I think even Americans with gold-plated insurance plans can understand that, despite how awesome we are at life, Americans pay more for every procedure that we get, compared to countries with more nationalized plans of any type.

If you don't see the bill, you don't know that.
posted by JPD at 4:11 PM on July 20, 2012


I would assume that nationally it's a normal distribution around the average.

Wouldn't it be a bimodal distribution - small pile of people with 100% paid for and then a majority of people lumped around something less than the mean?
posted by JPD at 4:14 PM on July 20, 2012 [1 favorite]


I think you mean insurer, not provider. Big difference

A thousand times this. In the US, people are conditioned to think of health insurance as synonymous with health care. But I think that's a big part of the problem, and that "insurance" is a really poor model for providing universal, or even near-universal, health care. I think a lot of opposition to HCR in the US (perhaps eg, and definitely some of my right-wing relatives) stems from the fact that people realize that insurance companies are, by and large, amoral scammers who will happily take your money and let you die. And Obamacare pretty much locks in the insurance model of health care. Not that long ago it made perfect sense to pay your healthcare costs yourself even if you weren't wealthy, and I suspect especially older conservatives see Obamacare as moving farther away from that (rosily misremembered but not entirely fictional) past state.

I think those are legit concerns, and I think to understand the opposition to HCR in the US you need to consider them. But I'm also hopeful that Obamacare weakens some of health insurance's regulatory and market captures, and we can use it as a stepping stone to a less horribly fucked up system. If there's a viable alternative proposal that doesn't involve simply letting masses of Americans die on the street, I haven't heard it.
posted by hattifattener at 4:23 PM on July 20, 2012


Kevin Street: No politician wants to be a noble sacrifice, they'd prefer to win and keep winning all the time.

It is precisely my point that there is a way to win that actually achieves something of value. In fact, that is the only way to win.

Consider what Obama has actually "won" with his health care plan: at best, an immensely expensive partial fix for the worst aspects of the current system. Even his fondest supporters are lukewarm about it. And he may still lose power. Had he organized for -- and achieved -- a publicly-funded universal system, he would have accomplished something truly worthy.

I do not dispute that most (not all) of today's politicians behave the way you say. I cannot name a single great achievement by even one of those. So what have they "won"?

If you give up what you want to accomplish in order to keep power, what power do you really have?
posted by dmayhood at 4:38 PM on July 20, 2012 [1 favorite]


So, what does health insurance cost in the U.S.? Depends where you are, but here's a précis:

"Report Highlights – Active Policies Surveyed in February 2011:

The average monthly premium paid for individual policies was $183, while the average premium paid for family policies was $414.

Between February 2010 and February 2011, the average premium increased 9.6% for individuals and 5.6% for families.

The average deductible for individual policies was $2,935, and the average deductible for family policies was $3,879.

Between February 2010 and February 2011, the average deductible increased 11.5% for individual policies and 9.9% for families.

Half of all individual policyholders paid $149 or less per month in premiums, and half of all family policy holders paid $353 or less for monthly premiums.

The average plan lifetime limit per member was $4.2 million. This average applies only to policies with specified limits. Though provisions of the Patient Protection and Affordable Care Act will phase out lifetime limits for most covered medical services, this report surveys policies in effect as of February 2011.

The range of average monthly premiums paid for individual plans across the United States fell between $119 in Iowa and $382 in New York*.

The range of average monthly premiums paid for family plans across the United States fell between $261 in Iowa and $932 in New York*.

More than a third (37.9%) of individual plan policyholders had an annual deductible of $2,000 or less.

Between February 2010 and February 2011 the average age of policyholders increased by 1.9 years.

Over seventeen percent (17.3%) of all plans were HSA-eligible.

The average premium paid for HSA-eligible plans was $177 for individuals and $389 for families.

Almost 100% of individual or family plan policyholders selected plans that included lab and x-ray (98.9%) and emergency room coverage (99.9%).

The majority of individual and family plan policyholders purchased plans that covered prescription drugs (88.4%) and chiropractic coverage (72.4%).

Policyholders also tended to select plans that offered preventive care benefits like OB/GYN (92.0%), periodic exams (89.3%) and well baby coverage (88.3%)."

Full report, with premiums, deductibles etc. broken out by state.[warning: .pdf]
posted by VikingSword at 4:44 PM on July 20, 2012 [1 favorite]


f you give up what you want to accomplish in order to keep power, what power do you really have?

mayhood, I was sorely disappointed in the manner in which health care reform negotiations were handled. I want single payer. But Obama isn't a dictator. He had to work with Congress. A Congress full of balky blue-dog Democrats and Republicans who had announced that they were going to do everything in their power to limit Obama to one term. Democrats do not fall in line in Congress the way Republicans do; it's like herding cats. I don't love every part of the ACA but I do love parts of it. It's a good start. I'm not going to go around beating my chest and rending my garments because in the face of enormous opposition, all we got was a good start.
posted by ambrosia at 4:45 PM on July 20, 2012 [1 favorite]


ambrosia, I admit abject ignorance of how the US political system works in practice. In my first post, though, I pointed out that, by all accounts, Obama is an ace grassroots organizer. There are ways of making your opponents' constituents do your work for you, if you can win them over. I only wondered why he did not use these grassroots organizing skills to force significant leaders of his opposition to adopt his own position. (Maybe he tried, but that is not my impression. Correct me if I am wrong.)

I think a good policy can be sold to damn near anybody, and Obama has shown in the past that he knows how to sell policy. For example, business leaders must be well aware of the horrendous cost they must pay for employee health care. Government health care in Canada gives us a significant competitive business advantage over the US because (1) it is cheaper over all, and (2) the cost is borne by everybody through taxes, not primarily by the employers. Tea Partiers may not care about this (or any other) argument, but business leaders understand it right away. It's going to save them money. Business small and large is Obama's natural ally on this policy. And ordinary people have obvious reason to support him.

Maybe in his final term Obama will show us what he can do ...
posted by dmayhood at 5:32 PM on July 20, 2012 [1 favorite]


caclwmr4: Removing this tax trick - removing the laws that allow this existing tax trick, not adding 500 more pages of regulations - should have been the very first step of changing and improving US health care, lowering insurance prices to everyone in the country. This could have been accomplished with one of Obama's executive orders literally instantly and overnight.

I don't know what country you think you live in (try turning off Glenn Beck) but the President cannot repeal tax laws by executive order.
posted by JackFlash at 5:53 PM on July 20, 2012 [1 favorite]


But if you are in the quite large category of having decent insurance and enough money to pay the deductible, your access to care is going to be pretty good.

No, it really isn't. You can't pick your own doctor in the USA - you have to find one that works with your insurance. When you change jobs you might have to doctors too, in fact in the USA the idea of a family doctor is almost foreign, because insurance BS means that people have to struggle really hard to keep the same doctor for more than a few years.

Furthermore, the amount of paperwork and wasted time in any US healthcare transaction is jaw-dropping. I have literally spent more time dealing with paperwork, forms, bills, and bullshit than I have spent being treated. People here assume that's normal. Elsewhere, I can pick a doctor I've never seen before, walk into a clinic I've never been to before, get treated, and the only paperwork might be signing the receipt for the medication.
posted by -harlequin- at 5:57 PM on July 20, 2012


> But Obama isn't a dictator.

He's not a negotiator, either. Starting by arresting people on your own team is a poor strategy. Then, spending a year trying to negotiate with the Republicans even though they publicly and repeatedly said that they would never agree with anything Mr. Obama did seems almost deliberately self-destructive. Certainly, nothing useful came out of that year in practice.

Worse than either of these is how Mr. Obama's initial proposal was so very weak. Anyone who's ever negotiated anything knows that you have to ask for a lot more than you expect to get. If your first offer is exactly what you hope to get, then you'll have trouble getting anything at all.

The fact is that single payer, which is basically the system that has worked the best elsewhere in the world, was completely discarded by Mr. Obama before we even stepped out of the gate. He'd guaranteed the insurance industry that they would continue to get their cut, and he delivered on that guarantee. He'd guaranteed before we started that we'd continue to get something that looked much like the current essentially broken model with a few of the bigger holes fixed.

For those of you who say, "Well, it's a step in the right direction," - it is, but we just don't get too many steps in the right direction, so they have to be really big ones.
posted by lupus_yonderboy at 6:00 PM on July 20, 2012 [1 favorite]


(And because no-one can keep their doctor, no-one has a doctor that knows their medical history inside-out, and knows them and how to read them, and because of that, doctors are less able to accurately interpret or diagnose or interact with patients. A striking difference to me is how rare it is to find someone in the USA who is pleased with their doctor. Happy with your doctor should be normal!)
posted by -harlequin- at 6:05 PM on July 20, 2012


I'm glad that PPACA is getting people coverage when they couldn't, and helping to protect people from some of the abuses perpetrated by the insurance industry, but as one of those 30 million I am not in any way excited to start spending money on an insurance plan that's going to have absurd deductibles and copays and exist for no reason other than so Obama can say he got me health insurance.

If you buy insurance through the exchange, you will have a choice of four benefit levels from bronze, silver, gold and platinum with a range of deductibles and copays. It will be your choice how much coverage you want, from low deductible to high deductible.

The plan will also subsidize the premiums and copays for those up to 400% of the poverty level. That means those single individuals earning up to $44,000 and a family of four earning up to $92,000 will be subsidized.
posted by JackFlash at 6:05 PM on July 20, 2012 [1 favorite]


In a very timely coincidence, I just received the largest bill associated with my recent hernia surgery. In a past thread, I noted that an earlier lab bill had been very high, but knocked down significantly with an "insurance discount" that wouldn't have applied to someone without insurance. That bill, however, was relatively small. For your amusement/displeasure, here is the breakdown of this bill:

Total Charges: $47,627.26
Payments: $6,449.48
Adjustments: $40,448.31
Account Balance: $729.47


Yep, as a person with excellent insurance coverage in the US, heavily subsidized by my employer, I owe $729 on this bill (bringing my total outlay so far to around $1,000.) This is, of course, not the important thing; I'm happy the amount I owe is so small. The important thing is that this bill alone would have been an undiscounted charge for $47,627.26 if I didn't have health insurance.

Something to think about, when comparing US health insurance to insurance in other countries.
posted by davejay at 6:07 PM on July 20, 2012 [2 favorites]


Right, and note that what was actually paid was only $6449. "Adjustment" means "writeoff".

So they think YOU have to pay them forty thousand dollars, but insurance companies? They can pay just $6500.

That's pretty fucked.
posted by Malor at 6:15 PM on July 20, 2012 [6 favorites]


>It's $3,300 a year total for me + 1 dependent.<

Even more for me with a wife and a son (who thankfully now can stay in my policy until he is finished with his schooling.
posted by twidget at 6:29 PM on July 20, 2012


if you give up what you want to accomplish in order to keep power, what power do you really have?

You get to stay in office and accomplish what is in the realm of the possible rather than handing over the keys to those who are going to do more damage with what power they manage to get.
posted by deanc at 6:33 PM on July 20, 2012


deanc: You get to stay in office and accomplish what is in the realm of the possible rather than handing over the keys to those who are going to do more damage with what power they manage to get.

Then you "govern" (if that is the word) for, and at the will of, your opponents.

This is a terribly sad comment to read. If you, or your candidate, will not make the case for the right thing, who will?

I hope this is you writing only after a long and especially difficult week.
posted by dmayhood at 7:06 PM on July 20, 2012 [1 favorite]


What a ridiculously condescending thing to say.
posted by spaltavian at 7:31 PM on July 20, 2012


One of my friends sold motorcycle lights on ebay a few years ago, pricing them under $10, and couldn't move them. He doubled the price in a later listing, and sold out.

Grad students at my university pay $60/month for basic medical and $400/year for the extended plan that includes dental/vision/physiotherapy. Tuition is $5,000/year with (as yet) no international grad student differential. The problem? US students think we're too cheap, so we can't be providing value. (By the way, the university is ranked top comprehensive in Canada, top 250 in most international rankings, hit the top 30 in recent rankings of universities under 50 years old)

Humans are strange in how we value things that cost more, even as we complain about the cost.

(More anecdata: My two emergency c-sections in BC cost $0, and the private room I requested was covered by my extended medical insurance. Two healthy babies: Priceless, literally. And I'm pretty sure that the fact that I make sideways babies who athletically wrap cords around their necks in utero is not a moral failing on my part.)
posted by wenat at 7:32 PM on July 20, 2012


This is a terribly sad comment to read. If you, or your candidate, will not make the case for the right thing, who will?

You know, that's governing. It's not choosing a hill to die on and letting them kill you. There is no such thing as "losing honorably" when your constituents are depending on you to stay in office so you can help them in ways that you can. Should Obama be willing to let a Republican come into office in 2013 so he can appoint more right wing Supreme Court justices? I would argue that Obama owes it to his supporters to avoid that outcome.

There's a place for political martyrs, but that place is not at the presidency.
posted by deanc at 7:36 PM on July 20, 2012 [1 favorite]


Obama is an ace grassroots organizer. There are ways of making your opponents' constituents do your work for you, if you can win them over. I only wondered why he did not use these grassroots organizing skills to force significant leaders of his opposition to adopt his own position.

I look forward to reading the memoir from a member of the administration's inner circle about why Obama did not do this. I suspect because Obama doesn't really think that "grassroots organizing" matters after elections, and his role as an organizer is highly overrated: the 2008 campaign was a well organized, well-oiled top-down operation dedicated to the sole purpose of getting Obama elected. Once in office, he seems to have thought that good policy could be hammered out by cultivating personal relationships with lawmakers and using the force of his charisma to come to mutual understandings, which is how I think he thought health care reform was going to happen. The idea of "boots on the ground" dedicated to pressuring legislators on the outside to get them to strike a deal with Obama seems pretty alien to the vision Obama and his inner circle had for his presidency.
posted by deanc at 7:44 PM on July 20, 2012 [1 favorite]


The important thing is that this bill alone would have been an undiscounted charge for $47,627.26 if I didn't have health insurance.
Right. Why? These practices are already violations of antitrust laws. Obamacare does not fix this, and the difference in price will stand. If someone pays the no-insurance penalty/tax/penalty/tax/penalty/tax/whatdayisit, then goes to the hospital for that same thing, they will still be hit with the $47,627.26 charge. Or higher.

"Adjustment" means "writeoff".
See above. Tax writeoff. Tax writeoff for a fraudulent overinflated price. Obamacare does not change this (although the number of such situations may be somewhat smaller).

But Obama isn't a dictator.
He seems to wish he was, or he thinks he is, with all of his speeches of how certain people just won't get out of his way, and they won't let him do what he wants, and his executive orders to not enforce laws he doesn't like or get in his way of more votes for him.

The plan will also subsidize the premiums and copays for those up to 400% of the poverty level.
It formally puts those certain people on that kind of welfare, and buys votes for Obama and Democrats. Being put on welfare is a psychological issue and/or trains people to rely on and expect, then demand, support from government.

Maybe in his final term Obama will show us what he can do ...
Oh good flying spaghetti monster, help us! As a lame duck, any conscious limits he has, keeping his wildest stuff in check so he can be re-elected, will be gone.

Meaning that the people with the best health plans are the people that need it the least.
It stays that way under Obamacare. Deliberately.

The original insurance plans were actually instituted by employers in a short labor market who wanted to offer an extra benefit above and beyond salary.
It is not at all that simple. Health insurance in the US goes back to 1798 at least. The disasterous condition we are in now began in WW2, when government allowed factories to attract some workers during (government price-fixing) wage controls by offering "free", and tax-free, health insurance above the frozen wages. 60-70 years later, most Americans think health insurance is supposed to come "from the employer" or "from the government".

but the President cannot repeal tax laws by executive order.
But he can effectively repeal immigration laws, RIGHT?
He can insist something is not a tax, only to have the Supremes ridicule that position and wind up calling that something a tax (and only because Roberts took a Zantac instead of a Pepcid one night). Then Obama continues to claim it's not a tax.

Under Obamacare, the US will continue to have the highest drug costs in the world, deliberately. (Except, possibly, India, which simply steals US drug formulas, and the US does nothing about it and keeps sending them foreign aid.)

26? Where did "26" come from? Why not 29? 35? 40? 50? 60? Where did the precise age of "26" come from? Why not make health insurance an inheritable asset? Bovine excrement.

I am in favor of a basic universal health care/insurance for every American and persons in the country legally. (Only.) It could be quite simple, it would cover everyone, it would be Constitutional without question, and it would LOWER costs for everyone. And it would not take 2700 pages. Obamacare is structured to raise costs and/or cause deterioration in service.

My views on health care and most other things were firm before I ever heard of Barack Hussein Obama.

Obamacare is a disaster no matter how much lipstick lots of people want to apply to it.
posted by caclwmr4 at 8:05 PM on July 20, 2012


As a lame duck, any conscious limits he has, keeping his wildest stuff in check so he can be re-elected, will be gone.

LOL. How did Rush Limbaugh find metafilter?
posted by Chekhovian at 8:30 PM on July 20, 2012 [6 favorites]


I'm curious: if you're in the State, uninsured, and need to go to the ER, is there any reason that you can't just go to the ER with no ID, give them a fake name and address and thus avoid the bill? I've heard that they can't legally turn anyone away.
posted by jb at 10:35 PM on July 20, 2012


I am baffled by the disconnect when it comes to choice: this lady seems to be (or was) upset by the perceived lack of choice that she would have under the Canadian healthcare system, but shocked by the fact that Canadians actually had the ability to choose to have an abortion or not (in terms of access to the procedure/whatnot). How can you be opposed to a lack of choice for yourself and opposed to others having the ability to choose? You either believe in freedom or you don't.

And we all know the Canadian system isn't perfect but no one's dying because they can't afford to go to the hospital.
posted by monkeymike at 10:43 PM on July 20, 2012


dmayhood:
The point of this story is this: that sometimes to implement good public policy, you have to fight. You must fight tooth and nail, and you must sometimes take some serious punishment.

With the greatest respect to my pro-Obama friends, this seems to have been a test that Mr Obama seriously failed in his first term.
dmayhood, there's a major structural difference between the US political system and the Canadian parliamentary system. In Canada, we have party discipline. This puts a great deal of power in the hands of the party leader: if you have a parliamentary majority, you can make major policy changes relatively quickly.

In the US, there's no party discipline: all votes are free votes. This means that it's much, much more difficult to make significant changes. There's much more negotiation, compromise, horse-trading, and log-rolling required. Under this system, it's not an option to push through a major change and then accept political martyrdom at the next election. This wasn't an option open to Obama.

See this explanation by political scientist Anthony King: Running Scared (Atlantic Monthly, January 1997).

Regarding the cost of the Canadian system: I went through the numbers about 10 years ago, and the annual per-capita cost of government health-care spending was about $2600 (out of total per-capita government spending of $15,000, at all levels of government). We have a rough balance of spending and taxation (both about 40% of GDP), so that means that on average we're paying about $2600 each year for public health care. (The monthly premiums that BC and other provinces charge are basically just a poll tax.) More recent figures.

The provinces are doing various things to try to keep costs down. It's a big issue because here, as elsewhere, old people vote and young people don't. So there's a danger of health-care costs crowding out education spending, which is not a great way to invest in the future.

Here in BC, the government has set up a 24-hour line where you can call and talk to a nurse. They've also published a pretty good health reference guide and sent a copy to every household. For relatively minor issues, it's a lot faster, easier, and no doubt cheaper to check the guide and perhaps call the nurses line than to go to an ER.

For a Canadian perspective on controlling health-care costs, see this 2009 essay by Charles Wright: Too Much Health Care. He argues for cost-benefit analysis. A specific example is the Therapeutics Initiative, which evaluates the effectiveness of pharmaceuticals. The ability of the provinces to say no to treatments based on their cost has been established by a 2004 Supreme Court ruling (regarding treatment for autism).
posted by russilwvong at 11:36 PM on July 20, 2012 [2 favorites]


I'm curious: if you're in the State, uninsured, and need to go to the ER, is there any reason that you can't just go to the ER with no ID, give them a fake name and address and thus avoid the bill? I've heard that they can't legally turn anyone away.

They may just turn you away, or they may simply let you wait in the ER waiting room until you die or get tired of waiting and leave.
posted by Pope Guilty at 1:06 AM on July 21, 2012


theplotchickens: "He's a partner in a small business. One thing about the ACA that's distressing him is that, while his company has the option of retaining their current excellent insurance, doing so will cost them an additional 8% of salaries in the form of tax. They'll probably have to drop the insurance, and go with ACA, because they have a small margin for survival as a business. This is the "lack of choice" that's concerning him, rather than concern over limited doctor options. To him, his choices are sign up for ACA, or go out of business."

I see no such tax if he provides insurance for his employees.


jb: "I'm curious: if you're in the State, uninsured, and need to go to the ER, is there any reason that you can't just go to the ER with no ID, give them a fake name and address and thus avoid the bill? I've heard that they can't legally turn anyone away."

Providing a false name to avoid the bill is a crime. Not being able to pay, on the other hand, is a purely civil matter. The last thing you want to do is give the hospital more leverage over you. Some of the for-profit hospital groups are very, very nasty when it comes to collecting what they're owed. OTOH, many of the non-profit hospitals waive fees for many to most of the uninsured and underinsured and work out reasonable payment plans for any remaining balance.
posted by wierdo at 1:56 AM on July 21, 2012


Not to derail Obama, but wasn't the significant loss that of Clinton? He came in with a mandate specifically to fix the healthy system and failed. The Republicans were not yet a monolithic "No"; they became that during Clinton's presidency. I have heard that many knowledgable media folk, including much of Hollywood, offered to help but the Clinton administration was too arrogant (and foolish) to accept this assistance. So the effective (anti) ad campaign was run by right wing interests. Since 9/11 everything in the States begins with security, back in 1992 the Cold War was over, the US was on top -- that was the politically ripe moment for progressive change and Clinton blew it. I hear a lot of disppointment about Obama, but Clinton was the great failed liberal hope.
posted by CCBC at 3:40 AM on July 21, 2012 [2 favorites]


Make that *health* system.
posted by CCBC at 3:50 AM on July 21, 2012


One more Canadian annecdote to refute what's her name. I'm from Newfoundland, traditionally one of the poorest parts of the country, and we've never, ever had to pay on a monthly basis for health care here either. My family has certainly gotten the benefits from it as well.

Five years ago my mother had a regular checkup with her GP, and offhandedly mentioned having the hiccups a lot. Unbeknownst to us, that's a symptom of esophageal cancer, and the GP booked an MRI appointment to check it out. The MRI came back with bad news, and mom started treatment right away. Total turn around time from the GP visit through diagnosis and first chemo appointment: two and a half weeks.

Just before my younger sister graduated from high school, she was hospitalized for about a month for severe abdominal pain while the doctors ran tests and finally sorted out what was wrong with her. They finally narrowed it down to Crohn's disease, and explored medical and surgical options to get it under control. Nearly twenty surgeries later, my sister is healthy, active and works as a paramedic with the local hospital, in fact.

The one, very, very slight beef I have with the Canadian system is that it can be a little tough to get treated in another province. As a university student, I was insured by Newfoundland though I was attending grad school in Ontario. I've got a mild condition requiring occasional blood work and a recurring prescription, but I didn't have a GP in Ontario. I discovered that a lot of walk in clinics refuse to deal with out of province insurance, or charge a $75 premium for it, as though I weren't insured at all. At my sister's suggestion, I went to an ER instead, early one Saturday morning (when she assured me it would be really, really quiet there and I wouldn't waste the doctor's time) and wasn't charged a penny for the prescription.

The Canadian system is not perfect, but it's been pretty damn good for me and mine.
posted by peppermind at 3:52 AM on July 21, 2012


caclwmr: [Obama] seems to wish he was, or he thinks he is, with all of his speeches of how certain people just won't get out of his way, and they won't let him do what he wants, and his executive orders to not enforce laws he doesn't like or get in his way of more votes for him.

Just stop. Your meme furtherance betrays you. You entirely destroy your credibility when you drag out those things that only people who get all their news through Republican talking points seem to believe. Whatever salient points you might have had are likely to be dismissed now. But I read the rest of your comment, and find that this prejudice is not misplaced.

Oh good flying spaghetti monster, help us! As a lame duck, any conscious limits he has, keeping his wildest stuff in check so he can be re-elected, will be gone.

He can insist something is not a tax, only to have the Supremes ridicule that position and wind up calling that something a tax (and only because Roberts took a Zantac instead of a Pepcid one night). Then Obama continues to claim it's not a tax.

Yeah, this kind of argument what I'm talking about.

Obamacare is a disaster no matter how much lipstick lots of people want to apply to it.

Are you honestly so lacking in memory that you forget all the concessions that had to be made to overcome the threat of a Republican filibuster? Whatever lacks there might be in (I spit out the term) Obamacare, you can lay them at their reprehensible feet.
posted by JHarris at 4:44 AM on July 21, 2012 [9 favorites]


Not to derail Obama, but wasn't the significant loss that of Clinton? He came in with a mandate specifically to fix the healthy system and failed. The Republicans were not yet a monolithic "No"; they became that during Clinton's presidency.

Actually, they were, and this was the beginning of it. A lot of republicans were wondering whether they should negotiate with the administration or offer a counter-proposal, and William Kristol wrote an influential article arguing that the republicans should pull out all the stops to defeat the health care plan and any health care plan, because once anything passed (a) it would be impossible to get rid of, and (b) it would allow the democrats to brand themselves as "the party of guaranteed health care."

There were other screwups, as you mention. But Republican opposition to the plan was a conscious political decision back then, just as it was with Obama.
posted by deanc at 5:32 AM on July 21, 2012 [2 favorites]


Why did [Obama] not use those skills to build support for a truly government-run, single-payer universal system?

Because he isn't the prime minister (and therefore has zero legislative power) and votes aren't whipped (so there's no way to coerce members into voting for things they don't like).
posted by one more dead town's last parade at 6:51 AM on July 21, 2012


Why did [Obama] not use those skills to build support for a truly government-run, single-payer universal system?

Did you notice that the ACA only barely passed the house by a vote of 219 to 212? And then the Democrats lost control of the house that same year due in large part to a reaction against the bill? Do you really think that there was any possible way for Obama to push through a more ambitious plan?
posted by octothorpe at 7:06 AM on July 21, 2012 [2 favorites]


This could have been accomplished with one of Obama's executive orders literally instantly and overnight.

Part of the reason we can't make any political process in America is because people have absolutely no idea how things work, yet have specific, strongly-held emotional beliefs about what should happen.
posted by spaltavian at 9:23 AM on July 21, 2012 [3 favorites]


Why did he not use those skills to build support for a truly government-run, single-payer universal system?

Why didn't he outlaw cancer? A test Obama truly failed.

Like I said, no idea how things work, strong opinions about what to do.
posted by spaltavian at 9:24 AM on July 21, 2012 [1 favorite]


As a lame duck, any conscious limits he has, keeping his wildest stuff in check so he can be re-elected, will be gone.

Actually, you probably can't even imagine just how fervently I wish this were true. Imagine Trojan-Horse-Obama winning a second term and enacting some actual legislation to actually fix the actual problems we face.

What will actually happen if he wins reelection is that middle-of-the-road-Obama is just going to centrist everything to death and kick the can down a road a few more years while the ignorant republican fucks bitch and moan about even his imposition of socialism is "destroying america".
posted by Chekhovian at 1:07 PM on July 21, 2012


This has been an interesting thread; and an even more interesting article.

As someone who thinks that elements of the American health care system come pretty close to constituting a crime against humanity, let me say this about the Canadian system:

There are elements of the Canadian system that are an infringement on freedom. In particular, the prohibition on buying private insurance for procedures covered by the public insurance system has led to massive inefficiencies (operating rooms unused while wait lists pile up because there's no more public money to pay doctors to perform procedures). It's also restricted the availability of health care resources in the country. If private money could be used to buy more equipment, and create incentives for doctors to work more, wait times in the public system could go down. It would have to be managed so that doctors didn't just defect to a private system altogether, but that could be achieved without preventing people from buying superior insurance, as they do in Europe. Unfortunately, because we're juxtaposed to the American system, and because Canadians can be mindless nationalists as much as anyone, any hint of private care is seen not as moving us towards Europe, but as the "Americanization" of health care, and denounced as an inhuman, capitalist plot. This has led to a lot of unnecessary suffering. Canada and the United States are two extremes - two of only three OECD countries, I think, which don't have both a universal public and available private system.

There are problems with wait lists in Canada. Anyone who lives here knows that. (I'd like to point out how dishonest Michael Moore's Sicko was in that respect.) The governments of some provinces have reacted to public outrage by throwing money at particular procedures - in particular knee and hip replacements - that are increasingly needed by the politically powerful boomers, but the basic problem remains that our system apportions resources from a limited pool, and cannot react to demand inputs without action at the political level. It would be far better if a complementary private system could use non-public resources to deal with a large portion of the demand that the public system can't deal with - by building more operating rooms if necessary, or paying doctors more for their time to fill the operating rooms when the public system can't, so that the capital base if fully utilized.

When you do run into a resources bottleneck in Canada - a serious medical problem that you can't get to the right specialist for, or whatever - you discover that there is a two-tiered system in this country, but it's not based on money, it's based on your connections (who in your family knows a doctor who can make the right calls) and your ability to advocate for yourself (tough luck, poor immigrants). Again, this is a phenomenon that too many Canadians are familiar with, but that you don't see from the outside.

In fact, the wait times in Canada have been bad enough that the Supreme Court came very close to saying that the prohibition on private insurance violated the Charter (without explicitly deciding the question). They're surely right - if you're going to force people into a system, you can't then deprive them of care. This is an issue that has not seen its last day before the Supreme Court.

You don't have to live here too long to read nightmare stories about some old woman who died after being left unattended in a hospital hallway for three days because there were no beds available. We have a genuine problem of under-resourcing. We also have a very serious long-term problem in funding the public system; it is consuming resources at a faster growth rate than general public revenues, which means that every year there's relatively less money to spend on education, the justice system, parks, whatever. It's only getting worse, and no government knows how to deal with it. We're facing a future of higher taxes and lower public services to take care of an aging population. It's not a utopian future.

A private system wouldn't be a cure-all; there's the problem that medical associations try to limit the number of new doctors to keep prices for their members high. Britain has problems with NHS funding in spite of its private system. And I'm very, very, grateful to live in Canada and not the U.S. - I've received excellent medical care in this system at no cost to me, and it's immensely preferable to the U.S. system on the whole, in my opinion, even if you don't have the same resources at the very high end of the scale (the U.S. system truly is world-beating if you have the right insurance). But I think we have to be honest about the Canadian system, as well, because it could be a lot better than it is.
posted by Dasein at 1:09 PM on July 21, 2012 [1 favorite]


Exactly. We should be looking at France and Germany, which have cheaper and better health outcomes than three Anglophone systems we always talk about.

Per Capita Total Expenditure on Health at Average Exchange Rate in 2010
Canada $5222
France $4691
Germany $4668
UK $3503
US $8632

Per Capita Government Expenditure on Health at Average Exchange Rate in 2010
Canada $3681
France $3652
Germany $3598
UK $2938
US $4437

The UK system has its faults at least in part because, despite New Labour's years of throwing money at it, it's run on a comparative shoestring. On the other hand you are right that France and Germany would probably be better models than the US - but that's because there are far more simmilarities in the systems so it would be less radical reform.

Source: World Health Organisation statistics
posted by Francis at 1:11 PM on July 21, 2012 [1 favorite]


It's not "goverrment mandated health care". It's "government mandated purchase of private insurance." I expect health care to intersect only coincidentally.
posted by telstar at 2:15 PM on July 21, 2012


I often wonder if religion contributes to some peoples resistance to any form of social safety net in the US.

If you expect a glorious afterlife, there is less motive to improve this life, and if you imbue this world with intenionality, it's easier to see other peoples misfortune as in some way their fault or a punishment or even a trial.
posted by PJLandis at 4:34 PM on July 21, 2012


telstar: "It's not "goverrment mandated health care". It's "government mandated purchase of private insurance." I expect health care to intersect only coincidentally."

There do still exist actual honest-to-goodness nonprofit health insurers out there. They should have a significant advantage over the for-profits going forward if only due to the relative ease of hitting the required MLR. Like most people are able to use a decent bank or a credit union if they desire, most people have available to them at least one non-profit insurance option.
posted by wierdo at 7:30 PM on July 21, 2012


Canadians can be mindless nationalists as much as anyone, any hint of private care is seen not as moving us towards Europe, but as the "Americanization" of health care, and denounced as an inhuman, capitalist plot.

Hello, Mirror-World.
posted by Chekhovian at 7:43 PM on July 21, 2012 [1 favorite]


A few weeks ago I took my uninsured roommate to the ER at midnight after she was stung by a bee. She's allergic. We waited for over four hours, she spent five minutes with a physician assistant (not an MD), and she was given a prescription to fill.

The bills that have come in so far are over $1200.

Any change will be good change.
posted by kostia at 11:48 PM on July 21, 2012 [2 favorites]


I work in (academic) biomedical research. I'm not going to go into specifics into exactly what since I'm fairly low on the ladder (doctoral candidate) and am not equipped to engage with the public regarding our work. But our lab, and our colleagues in the field, are very close to getting some devices out that will hopefully help a lot of people that currently have no therapeutic option.

I tell you, nothing is more depressing as I sit here churning through data late at night than the thought that whatever comes out of this effort - which represents years and years of work by hundreds (if not thousands) of people and funded by everyone's tax dollars/government - will only benefit those few privileged or wealthy enough to afford the technology.

I can't honestly say I know exactly what system of healthcare will work for the United States, but I can tell you this - small government would never have made any of this possible and "the market" never would've taken on the risk of a 40-year R&D project with uncertain overheads and outcomes. If you see a commercial medical device, drug, what have you, you can be damned sure it was built on the back of publicly-funded research, and that means the vendor side of medicine is already government-subsidized (or socialized, depending on how you want to look at it). Single-payer, public option, socialized medicine, it doesn't matter; we ALREADY paid for it, we shouldn't let them sell it back to us.
posted by Tikirific at 4:52 AM on July 22, 2012 [8 favorites]


> Do you really think that there was any possible way for Obama to push through a more ambitious plan?

Absolutely I do - but we won't know because he didn't even try. He asked for something modest, and got it.

The plan he eventually got was not so far from his initial plan. From what I and most people know about negotiation, that indicates bad results. You should always ask for something that is quite a bit more than you actually would be satisfied with.

I argued specifically above (and many other times on the blue) what should have been done - you should perhaps reply to those arguments rather than saying, "These terrible results were the best we could do!"

But here I'm going to try to give explanations as to why this happened - something I didn't figure out (a good guess at) until comparatively recently.

I believe that Mr. Obama and his team's strategizing went like this:

1. Mr. Obama's re-election stands or falls on the success of health care reform.
2. But we don't get extra points with the electorate for a Big Win.
3. So passing health care reform is a must, but the specifics aren't so important.

and, unfortunately:

4. Americans think Big Government is bad, so any solution has to use the "free market".

A lot of the events in the health care reform saga become much clearer to me if I postulate the above four points. For example, this explains the puzzling hostility to single payer advocates and the "public option".

Or, had I been a Democratic strategist, the very first thing I'd have done is get real numbers ffs!, take a poll and find out which parts of the medical establishment are respected and valued.

When that poll showed that people on the Left and Right considered Medicare to be very popular, far more popular than Congress, surely my mind would instantly leap to "Expand Medicare To Cover Everyone"! Why did this not happen? Didn't they see those scrawled "Governments hand's off my medicare" signs?

Unfortunately, 4. explains this as well.

The Democrats strategists don't understand the key idea that the Republicans have so well - you don't watch the polls to see what people think and then tell them what they want to hear - you tell them what the right answer is, tell them in many different ways, and then watch the polls to see how well your message is getting across. As long as they try to follow public opinion rather than lead it, we will continue our relentless swing to the right.

The one part that I still don't understand is why the health care reform "negotiation" process was allowed to take so long! It should have been clear to Democrats within the few weeks that Republicans, who had consistently claimed they would never support any health care reform under any circumstances, were serious about not cooperating. The solution they came up with the better part of a year later would have been entirely possible at any time... and everyone would have respected Mr. Obama for his aggression and strength in bringing the matter to a close in a few months.
posted by lupus_yonderboy at 4:58 AM on July 22, 2012 [2 favorites]


The one part that I still don't understand is why the health care reform "negotiation" process was allowed to take so long!

It was widely regarded as a mistake by the Clinton administration for him to come up with a reform bill within his administration and then present it to congress as something to pass-- ultimately, Congress had no personal stake in the bill and was less interested in passing it than if it were something they had come up with on their own. So the Obama administration decided to hand over the responsibility of coming up with the precise policies to Congress.

As to why negotiation dragged out for so long, part of that process meant that they expected some republican senators to gain some buy-in, as well (keep in mind that they were still ostensibly in favor of some kind of reform). The Democratic Senators controlled that negotiation process, and they did not figure out that the Republicans were stringing them along for a long time.
posted by deanc at 5:51 AM on July 22, 2012


> The Democratic Senators controlled that negotiation process, and they did not figure out that the Republicans were stringing them along for a long time.

OK - but doesn't that seem objectively, er, stupid? I mean, the Republicans went on record over and over again as saying that they'd never agree to anything at all... and then they didn't. Why would this be a surprise to anyone at all?
posted by lupus_yonderboy at 6:07 AM on July 22, 2012


OK - but doesn't that seem objectively, er, stupid? I mean, the Republicans went on record over and over again as saying that they'd never agree to anything at all

No, they didn't. In 2009, there were still adults in the Republican Senate caucus, and the administration only needed a few. No one expected the astro-turfing against the bill to be so successful; that scared off the handful of Republican votes needed to smooth the process. The original game plan never needed to go through Lieberman and Nelson, because at the start of the process there was every reason to believe we were going to get to 60 without them, so they'd hop on board anyway. Snowe, Collins, et al. had to back off because the messaging against the bill was so successful and Obama had to go back hat in hand to the Blue Dogs, who then controlled the process.
posted by spaltavian at 7:51 AM on July 22, 2012


deanc: The idea of "boots on the ground" dedicated to pressuring legislators on the outside to get them to strike a deal with Obama seems pretty alien to the vision Obama and his inner circle had for his presidency.

Thanks for this observation and your other arguments.

The only additional comment I would make is that this approach (grassroots boots on the ground) remains viable and ready to be tried. It works anywhere there is an open electoral system (and many not-so-open ones). It worked for the great American community organizer Saul Alinsky, it worked for Martin Luther King, it once worked for Barack Obama, and it can still work for him. It gives you some power with which to negotiate, which inevitably you must do. It does take committed, clear-eyed, courageous leadership.

For what it may be worth, I have spent 30 years working on left-wing politics in southern Alberta, a political environment that is every bit as reactionary as most US red states. On the rare occasions that we win, we do it pretty much in this way.
posted by dmayhood at 10:07 AM on July 22, 2012


PJLandis: I often wonder if religion contributes to some people's resistance to any form of social safety net in the US.

That wasn't the case in Canada, where the church played a leading role in the establishment of the welfare state. CCF leaders J. S. Woodworth, Tommy Douglas, and Stanley Knowles were all Protestant ministers.

I think it's more a question of solidarity, or lack of it. To what extent do we feel that we're part of an integrated society, that we're all in this together? Conversely, to what extent do we regard others (the poor, for example, or ethnic minorities, or public employees like teachers and nurses) with contempt or distrust, thinking that they're trying to take advantage of us?
posted by russilwvong at 10:35 PM on July 22, 2012 [2 favorites]


and everyone would have respected Mr. Obama for his aggression and strength in bringing the matter to a close in a few months.

You appear to have missed how often he is accused of ramming everything down everyone's throat.
posted by flaterik at 11:31 PM on July 23, 2012


Here's a follow-up to the first piece: Why I used to be afraid of Universal Health Care
posted by homunculus at 7:20 PM on July 30, 2012 [1 favorite]


And in other news: Romney’s Israel healthcare stunner - The candidate appears to endorse a government-dominated universal care system
posted by homunculus at 7:21 PM on July 30, 2012 [1 favorite]


"That wasn't the case in Canada, where the church played a leading role in the establishment of the welfare state"

I see a difference when we're discussing a church with a hierarchy that makes decisions as opposed to Evangelical Christians who have less of a central authority.

In the US the Catholic Chuch is in favor of universal healthcare but they don't always represent the lay persons view (evolution is a good example as most US Catholics don't believe in evolution) and I get the sense that Evangelicals as a whole are opposed to any universal healthcare coverage.

Hence, maybe sophisticated theologians see universal healthcare as supported by their beliefs but it doesn't seem to me that your average US Christian holds a similar view.
posted by PJLandis at 10:32 AM on July 31, 2012


In the US the Catholic Chuch is in favor of universal healthcare but they don't always represent the lay persons view (evolution is a good example as most US Catholics don't believe in evolution)

Pretty sure that's not the case. Catholics as a population are about as literalist when it comes to interpreting the bible as main line protestants.

Wiki:A 2005 Pew Research Center poll found that 70% of evangelical Christians believed that living organisms have not changed since their creation, but only 31% of Catholics and 32% of mainline Protestants shared this opinion.
posted by JPD at 12:29 PM on July 31, 2012 [1 favorite]


My point was that 0% of the Catholic hierarchy denies evolution, yet 31% of the members still hold such a belief even though it's contrary to the teaching of their church.
posted by PJLandis at 1:31 PM on July 31, 2012


I may have been considering "guided evolution," and I was looking at this PEW poll
http://www.pewforum.org/Science-and-Bioethics/Public-Opinion-on-Religion-and-Science-in-the-United-States.aspx#2)

Still, that's quite a few lay Catholics out of step with the Pope.
posted by PJLandis at 1:42 PM on July 31, 2012


And I think the polls bear me out with about half of all US Catholics opposing the Affordable Care Act, despite the Church technically supporting everything but the contraception issue.
posted by PJLandis at 1:46 PM on July 31, 2012


Hence, maybe sophisticated theologians see universal healthcare as supported by their beliefs but it doesn't seem to me that your average US Christian holds a similar view.

My subjective impression is that many practicing Christians in the US feel like they belong to a beleaguered minority, besieged by an alien and rapidly-changing secular culture (particularly as expressed in movies and television). Someone who feels this way is unlikely to feel a great deal of solidarity with society as a whole.

This would certainly have been the case for the author of the original article, a former member of the "Quiverfull" movement.

gracedissolved explained this viewpoint very well.
posted by russilwvong at 1:04 AM on August 1, 2012


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