American Exceptionalism
March 25, 2019 9:21 AM   Subscribe

“When I studied in the US for a master’s program I got a cold and a sore throat and I didn’t get well for about more than two weeks. I went to the hospital, but at that time I had student insurance, so I only paid about $40—that was around 35 years ago. At the time I thought it was so expensive...”. 5 Women on What It's Actually Like to Have Universal Health Care (Elle)
posted by The Whelk (71 comments total) 30 users marked this as a favorite
 
As a Canadian in the US I hate having to second guess whether to go to the doctor, and the “you pay $500 - but this is not a bill!!” insurance statements are supremely confusing.

Pregnant in Canada - paid $80 in hospital parking for 4-day stay, and upgraded to private room $200 but reclaimed this on my work insurance.
Pregnant in US - paid $1000 so far and I’m only 7months along. This is With the Swanky Insurance Package.

I have friends with a sick baby who is in and out of the hospital, I don’t know how they’d manage in the US.
posted by St. Peepsburg at 9:34 AM on March 25 [10 favorites]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?
I'll take "things which shouldn't even be questions" for $3 trillion.
posted by clawsoon at 9:41 AM on March 25 [51 favorites]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

This shouldn't be a thing in Canada, but I'm worried about going part-time at my job and losing my prescription coverage. I don't even have a very expensive prescription, but it's been a nice feeling of security to know that if I did get a more expensive prescription, that would be covered. I've also seen the dentist more often.

Which is just all to say: prescriptions and dental care are an important part of medical care, and should be covered under our universal health care. So should physiotherapy, occupational therapy, psychologists, etc; a lot of these allied health services, especially physiotherapy, help reduce the burden on the MD/hospital system by helping people be less disabled. Covering them would save us money in the long run.

(Non-evidence-based alternative care is another matter - if/when they open up medicare to non-MD services, this will be a fight: which alternative therapies are covered? I don't want non-evidence-based (e.g. homeopathy) to be covered by public funds).
posted by jb at 9:52 AM on March 25 [19 favorites]


The only thing that truly terrifies me is that I'll get hit by a bus and my dogshit health insurance won't pay for it. And that's not an indictment of my employer. He does what he can and I respect him for that, but I don't get the Gold Plan (yes, that's what they call itl).

I'm betting $5000 that I won't need emergency medical care. This may come as a shock, but I don't have $5000 laying around.
posted by East14thTaco at 10:01 AM on March 25 [2 favorites]


From the article: He hasn’t had to get any prescriptions yet and not all prescriptions are free for kids, but a lot are free under the age of 25. That’s a newer thing in Ontario the past few years.

With a change of government that is getting altered slightly. Ontario also, thankfully, has the Trillium Drug Program which does help with the sometimes insane costs for prescriptions. But saying that I really wish, at the very least, dental, physio & prescriptions were covered by Canadian universal care.
posted by Ashwagandha at 10:04 AM on March 25 [3 favorites]


Which is just all to say: prescriptions and dental care are an important part of medical care, and should be covered under our universal health care. So should physiotherapy, occupational therapy, psychologists, etc; a lot of these allied health services, especially physiotherapy, help reduce the burden on the MD/hospital system by helping people be less disabled. Covering them would save us money in the long run.

This. As an MD in Canada, I see so many people who would really benefit from allied health support, but can't afford it because they don't have supplementary insurance. There are some publicly-funded options, but only in some areas, and there are some hoops that you have to jump through to get, say, physiotherapy. It's perhaps not as drastic in the US but people still do suffer if they changes jobs or relationships and don't have access to this kind of coverage.
posted by greatgefilte at 10:05 AM on March 25 [10 favorites]


*not as drastic as in the US...
posted by greatgefilte at 10:14 AM on March 25


Without universal coverage we put many, many people into bankruptcy. Someone I know just got divorced and thus lost his health coverage. He was extremely depressed and failed to take care of himself, including failing to sign up for Obamacare and failing to do anything about severe diabetes. Now he has ended up in hospital where they cut his leg off below the knee. Anything he has left after the divorce will now be gone, he may become bankrupt and he cannot get insurance until next January. The only way to get covered is get a job with employee benefits (unless I am missing something) and that is going to be hard with his mental illness and physical disability. He was the stay at home parent and hasn't worked at a job in years.
posted by caddis at 10:19 AM on March 25 [9 favorites]


I've lived with Canadian (OHIP), British (NHS) and now American (employer based Blue Cross / Blue Shield) healthcare. I've also experience French healthcare (wonderful even thought I had no clue what the hell was going on!).

I had no idea that in America I would have to become a quasi-lawyer/quasi-accountant/quasi-doctor to stay quasi-alive and financially afloat.
posted by srboisvert at 10:24 AM on March 25 [17 favorites]


A decade ago my friends stopped dying from overdose or suicide and started dying from the US healthcare system. The latest died homeless with untreated diabetes, of exposure. Funkadelic was right - America eats its young.
posted by Radiophonic Oddity at 10:28 AM on March 25 [18 favorites]


Without universal coverage we put many, many people into bankruptcy.

Way back in the late 90s, I briefly had a temp job that ended up being at the nexus of a whole bunch of issues that were on very few peoples' radar back then but then a few years later whoa nelly. I was working for a bank that was furiously buying up sub-prime loans by the bucketload. My job was to take all these paper loan files and physically sort them out so that they reflected the order that the new servicer preferred. So I got a pretty up close and personal look at the lives of people who took out sub-prime loans. Two things immediately jumped out as the common denominator for all these folks: divorce and/or a catastrophic health event resulting in massive medical bills. It really put the fear of god in to 23-year-old unmarried me.

And in fact a couple years later I "proposed" that me and my now-husband get married because he was going to embark on grad school (professional program, so no TA fellowship insurance) and I was working full time with good insurance. And since we'd both had that same temp job a couple years earlier and learned the same lesson about being uninsured there wasn't even a moment of debate. It was the only rational thing to do.
posted by soren_lorensen at 10:30 AM on March 25 [17 favorites]



Without universal coverage we put many, many people into bankruptcy.



More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years, according to a study published last year in the American Journal of Medicine. Cancer patients are 2.65 times more likely to file for bankruptcy than those without cancer, and bankruptcy puts them at a higher risk for early death, according to research.

1 in 4 Americans can't cover a 400$ emergency
posted by The Whelk at 10:45 AM on March 25 [14 favorites]


...and it's 4 in 10, even worse.
posted by lazaruslong at 10:52 AM on March 25


I went on an extended rant to my mother this weekend about this story on lung transplant recipients and their living expenses. Having grown up in a small town in Northern BC, I am sadly familiar with 'oh, we don't have that specialist here, you'll have to go to Vancouver for that' and how much that ends up costing in theoretically non-medical expenses like plane tickets, hotels and meals.

I know that having to pay your living expenses while you're in a large city to receive health care is an improvement over having to pay your living expenses AND your medical expenses while you're in a large city to receive health care, but it's still, in my opinion, a national disgrace that people are faced with those kinds of expenses. We should be better than that.
posted by jacquilynne at 10:53 AM on March 25 [10 favorites]


Pharmacare in some form is being mooted about as a Liberal campaign promise in the Canadian fall election.
posted by bonehead at 11:10 AM on March 25


I think the US switching to free* healthcare would help the rest of us. There are lots of problems in socialized systems that governments need to put hard work and money into fixing, but we sometimes let them be handwaved away because of our relief at not having to live under the US healthcare system.

*As some wag pointed out, if the government gave me a cheese sandwich I'd call it a free sandwich, so why shouldn't it be the same for healthcare?
posted by clawsoon at 11:31 AM on March 25 [4 favorites]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

The sleazy, amoral main character in Nightcrawler blackmails a woman into sleeping with him by threatening to take actions that would probably cause her to be fired and (it is explicitly stated) lose her health insurance.

The public relations campaign continually being waged to convince Americans that their health care system is the world's best is gaslighting at its most inexplicably effective. Every time there's an article and thread like this I come away wondering how anyone who isn't rich in the U.S. makes it to 40 without dying or going bankrupt.
posted by The Card Cheat at 11:37 AM on March 25 [7 favorites]


Every time there's an article and thread like this I come away wondering how anyone who isn't rich in the U.S. makes it to 40 without dying or going bankrupt.

The same way most people in the U.S. become rich - through luck. And in both cases, no one likes to acknowledge how much luck plays a part.
posted by ZeusHumms at 11:55 AM on March 25 [11 favorites]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

Heh. When I discovered the university had canceled my health insurance on the same day I discovered I probably had malaria, I got really pissed off at my then-boyfriend-of-4-years because I suggested we could get married so I would have access to his health insurance and he suggested a domestic partnership instead.

Anyways, I ended up with a $45,000 hospital bill but I hadn't been paid in a year (my grad school stipend was tied to teaching; I'd been in the forest) so the state declared me indigent and forgave the hospital bill, and my ex and I neither got married nor domestic partnershipped.
posted by ChuraChura at 12:21 PM on March 25 [24 favorites]


Having been without health insurance for the past two months courtesy of a Workday snafu by my employers, and having sent an email the other day that boiled down to "I have paid $900 in physiotherapy out-of-pocket costs since you abruptly canceled my health insurance coverage and told me you would fix it, and my wife needs to take health tests for nursing school classes to the tune of $2000 in the next week, and I make $2000 per month..."

Well. The article feels just a touch too close to home.

(As of yesterday I have been assured, again, that I have health insurance. We shall see.)
posted by sciatrix at 12:38 PM on March 25 [5 favorites]


I always tell people from the 'States: I have lived in the US, and at various times had very good insurance, bad insurance, and no insurance.

Let me tell you, having universal health care in Canada is better than all three. I have never waited longer in an ER or to see a doctor than I would have in the US, and the lack of uncertainty about costs, billing, etc. (even with good insurance) is a huge difference.

The last time I broke my wrist, all I paid was $40, and that was so I could get a fancy fiberglass cast instead of a regular plastic one.
posted by TheWhiteSkull at 12:42 PM on March 25 [13 favorites]


The same way most people in the U.S. become rich - through luck. And in both cases, no one likes to acknowledge how much luck plays a part.

Or cowardice, honestly. There are things that my insurance covers for me that others like me aren't lucky enough to have, and I try not to think about it too hard about why because I am not that strong.

It's difficult to avoid it sometimes though when someone like you is next to you, staring back.
posted by anem0ne at 12:53 PM on March 25 [1 favorite]


As a Canadian, I love our health program, but it's not perfect. Two points come to mind:

1) The very best at everything (surgeons, researchers, specialists of any kind) tend to end up in the States where they can make way more money. If you want the BEST of anything, you need to go to the States. Our rich hockey players, actors and business leaders head down to the states for their medical care.

2) Health care costs are taking up something like 50-60% of our government's budgets. We need to find innovative ways to curb this as it's unsustainable. But, I'm optimistic that there's things that can be done. We haven't really dug into ways to reduce costs as much as we have investigated how to make people live longer and better (for good reason).
posted by Phreesh at 12:56 PM on March 25 [1 favorite]


Health care costs in Ontario are about 30% of the budget, not 50 to 60%.

If you take that bastion of left-wing journalism, The National Post, at its word Canada spends about 11% of GDP on health care:

"The Canadian Institute for Health Information (CIHI) believes Canada spent approximately $228 billion on health care in 2016. That’s 11.1 per cent of Canada’s entire GDP and $6,299 for every Canadian resident. That per capita rate would put Canada near the high end of what other advanced economies pay. According to the CIHI, in 2014, the last year for which comparable data was available, Canada spent $5,543 per resident, more than the United Kingdom ($4,986) and Australia ($5,187) but less than Sweden ($6,245) and far less than the United States ($11,126)"

So half as much per person as the USA.
posted by fimbulvetr at 1:08 PM on March 25 [22 favorites]


I see my numbers were off by a considerable amount. Here in Alberta, we spend about 40%. My apologies for making a large problem seem like a REALLY large problem.

That said, don't you think that's an awful lot? Don't you think that we could do better at curbing costs in a country with an ageing population?
posted by Phreesh at 1:21 PM on March 25


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

I am, indeed, an American.
posted by East14thTaco at 1:37 PM on March 25 [8 favorites]


That said, don't you think that's an awful lot? Don't you think that we could do better at curbing costs in a country with an ageing population?

No.

Our tax rate is not that different from the US and we seem to get more for it. I know that income tax is not the only tax but my jaw dropped when I learned what a friend was paying for property tax in New Jersey -- 3X what I pay in Toronto for a similarly priced home -- and I started asking around. I think Canadians should be very careful about taking American news around taxation and how the US is so great and Canada is so awful about taxes.

Also, we have a lot of remote communities who don't get adequate health care and the health care they get is by nature going to be pretty expensive. You can't just make a blanket statement that we could curb costs. What is it that you think we could cut?

I basically think the idea that Canadian taxes are too high on the average Canadian is a myth and that in general (not always in specific policy cases) our governments have historically managed them decently. There are exceptions but I don't generally think for the most part health care is badly managed, unless you look at e-Health or Orange Air in Ontario.
posted by warriorqueen at 1:38 PM on March 25 [23 favorites]


Don't you think that we could do better at curbing costs in a country with an ageing population?

I don't know if it's within the scope of the discussion, but that's somewhat a loaded question? The answer to that is almost always "yes", but the sticky wicket is always "how?"

Because I assure you, the reason why so many people die in America from fighting with their insurance companies is precisely because those insurance companies are trying to figure out how to curb costs.

I have a friend who ended up paying a staggering amount of money last year because he got stung by a "copay accumulator" which pretty much hoovers up all the money pharma companies use to try to make their more high-end drugs affordable to the middle class, because otherwise you'd hid the deductible quickly and make the insurance companies pay for them. Which is great if we're talking about "curbing costs", not so great if we're talking about a medication that lets my friend actually use his hands to grasp things.

I am lucky to have almost all of my transition-related expenses covered by insurance (I hate my job but the insurance is like golden handcuffs) or the related FSA, but I am terrified of my job moving to another state--while I'm a dev and can work remote, moving to a different state means that my insurance might end up under a different rules regime, meaning that a lot of the coverage could be cut. After, it's about "curbing costs".

And these are just costs that are often curbed for people who don't have a terminal, life-threatening condition, not exactly.

So, yeah. We could do better at curbing costs, but what do you mean by that? How far will you go? Because the way the exceptional American system is, with its patchwork of regulations and how easily so much of it is made hash by legalese difficult for even lawyers to understand... they're curbing costs left and right.
posted by anem0ne at 1:44 PM on March 25 [3 favorites]


There are many things about the USA that I find strange, which is not really a judgement, people from the US would likely find an equal amount strange looking in the other direction, but the nexus of wtf is always healthcare.

It's attached to an employer? You can get access to you your partner's, but only if you marry? It's a terrible system but the most expensive in the world? People would rather not have a cheaper or more equitable system, due to an allergy to the word socialism?

I'm not sure I'll ever understand. This is a much better skinned cat in most of the developed world.
posted by deadwax at 1:48 PM on March 25 [18 favorites]


Also, for reference, here are some major events in my kids' and my health lives.

OB care, Delivery, transfer to world-class Sick Kids, NICU stay for my daughter - $200 in parking including prenatal visits and hospital new parent group training. However the system did fail her, which is a different level of cost. I have sat with that for 15 years now and I still support Canadian medicine.

OB care, delivery for my son, including extra ultrasounds, in a world-class high-risk pregnancy unit - $40 in parking

OB care, ante-natal hospitalizations, ER drama, delivery, NICU stay for my younger son in the same unit - $140 parking

Son's emergency appendectomy, including rush from Scarborough hospital to world-class Sick Kids hospital, with a nurse in the ambulance - $50 in parking, thank you for parent price parking pass. $22 in copayments for prescriptions.

Son's cataract surgeries with people-are-here-from-all-over-to-train-with-her surgeon at the incredibly busy Sick Kids eye clinic - $100 in parking, about $60 in copayments for a wide variety of drops and ointments. Also $150 in beads and toys to get him to let us put the drops in.

My broken leg, including surgery last year - $30 in parking + we did have to pay physio and it added up to about $500 after I hit an insurance cap. I am back doing martial arts on that leg.

What I think would maybe blow Americans' minds is that in all those experiences, I only had to submit paperwork for the physio. Everything else was either done at the counter (drug card) or...we swiped our health card. Or in my daughter's case, she got her health card when a poor volunteer student had to come into my blood-soaked, papers-all-over-from-the-resuscitation delivery room and ask me to sign her forms so she could have her own card that would go to the Sick Kids NICU with her.

The idea that I would have to weight costs, figure out what's covered, resubmit, etc. etc. is just - not there. I feel so bad for the stress I see my family (and their doctors) go through when they have to justify everything to these huge companies.
posted by warriorqueen at 1:50 PM on March 25 [8 favorites]


American. I have a good insurance plan. It's really good. But still my out of pocket maxium for my family is still about 7,000 per year. I have met that every year pretty much.

That doesn't include the taxes I pay. Or whatever else I need. It doesn't include the bills for uncovered services (like I has ablations for Endometrosis but they didn't cover some of them in a particular area so so even though i had met my out of pocket max I still owed 2000 MORE ish) I'm not explaining this well.

Healthcare will take everything. Its in the law. You can't get medicaid until you have less than 2000 in assets excluding a house. So many people lose everything and It's not coming back. SSDI takes two years from approval to get medicare. It can be five years uninsured with a disability depending on how long it takes to get approved.

I just live terrified .
posted by AlexiaSky at 2:01 PM on March 25 [9 favorites]


warriorqueen: What I think would maybe blow Americans' minds is that in all those experiences, I only had to submit paperwork for the physio. Everything else was either done at the counter (drug card) or...we swiped our health card.

And that doesn't just affect patients:

U.S. doctors spend four times more on paperwork than Canadian counterparts

[American] Doctors Wasting Over Two-Thirds Of Their Time Doing Paperwork

Americans spend twice as much money on healthcare as anybody else does. Imagine if as much as possible of that money was spent on care instead of on paperwork. Imagine if everybody working at health insurance companies was retrained as a doctor, nurse, or technician.
posted by clawsoon at 2:03 PM on March 25 [12 favorites]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

"Have you ever?" Oh good gods. I was born and raised in the United States. I'm 51 years old. Until the ACA passed five years ago, there had never been a time in my entire adult life that I've had access to medical insurance or decent health care without a job or a partner. In fact, access to medical insurance has played a major part in every single major life decision I've ever made about employment, marriage, higher education, and domestic partnership. Even when I lived in Canada for two years, I only qualified for the care I got because I was married.

Access to resources is why I put up with so much unreciprocated emotional labor when I was married. I don't even know what it would feel like to be free to make a decision about employment or marriage without the pressure of needing access to health insurance.

And even now, as a self-employed and long-divorced single woman without kids, I only qualify for Medicaid because my income is below the federal poverty level and I happen to live in a state that adopted the Medicaid expansion. I get very good care through Kaiser Permanente via Medicaid. But it comes at the price of keeping me stuck in a poverty trap, aka "benefits cliff."

If I earn even one dollar above the cut-off amount (about $1400), I will no longer qualify, and the state will cut off my health insurance completely. I can't afford to let that happen, as affordable health care is what enables me to work for a living in the first place, and I won't be able to afford a decent insurance plan on the exchanges otherwise. So because I'm unwilling to break the law by concealing income I could earn under the table, I'm forced into a position where I have no viable choice but to deliberately limit my income (i.e., turn down paid work every single month) in order to keep my affordable health insurance. There's also a very low liquid asset limit for benefits recipients ($2200) that prevents me from legally saving enough money to get out of the poverty trap. It's maddening.

This does not bode well for my future, to put it mildly. It's one of the many reasons I'm looking for a job in Sweden. I sure hope I get hired in Sweden and can move there before I turn 55. If I remain in the U.S. after that age and need certain kinds of care, the state can use estate recovery to seize my assets.

I don't think I will RTFA despite my interest in this topic. I'd rather not spend the day green with envy of people who don't even have to think about these things, let alone center major life decisions around them.
posted by velvet winter at 2:15 PM on March 25 [22 favorites]


East14thTaco: "Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

I am, indeed, an American.
"

As an American I almost didn't understand the question at first. Or why anyone would not automatically know that the answer is going to be "yes".
posted by octothorpe at 2:16 PM on March 25 [6 favorites]


Canadian living in the US.

I recently had the experience of watching two friends go through extensive serious issues that landed them in hospital, one at QEII in Halifax, NS, and the other at St Thomas Medical Center in Nashville, TN. I stayed with them both for several days in hospital to make myself useful, and the experiences were very similar. The level of care provided was substantially similar. The quality of the doctors and nurses was substantially similar. The Canadian hospital didn't have those things that knead your calves after surgery and we had to do it manually, but otherwise afaict everything was pretty similar.

The US friend came out with a $12k bill over and above his very good insurance. The Canadian friend was entirely relieved of that sort of burden of worry.

That's not to say there aren't serious issues in Canada. It's just that the serious issues all exist in the US too.

I pay a monthly premium of about $100 for my healthcare (which is very low for the US - I work for a hospital - and is part of why I will never leave my job) and I have a $7,500 deductible. In the years that I have hit my deductible, I've spent $9,500 on healthcare (not counting dental or eyeglasses, for which I pay out of pocket).

That's just about exactly a quarter of my income, which is a bit more than I paid TOTAL in taxes when I lived in Nova Scotia. Of course lower taxes don't make up for health expenses! I'm only able to weather these sorts of medical events because I live with three other wage-earning adults and didn't have kids. If I ever lose my job, I will be every bit as vulnerable as the next American. It's bonkers.
posted by joannemerriam at 2:28 PM on March 25 [7 favorites]


I don't generally think for the most part health care is badly managed

I do think the way general practitioners and preventative care and ancillary stuff (drugs, therapy, physio, glasses, dental, etc) is poorly handled. There has been all the stuff in the news about GPs saying you can only bring up one issue a time, and of course in so many places it's almost impossible to find one (mine retired and I just need to wait until someone has space, and I have about zero choice on any of it). It could be worse managed, for sure, but I don't think it's done well.

But I think for urgent care things generally work quite well here, though for some reason the fancy new hospital has just this giant room for jaundiced infants where ALL the infants and ALL the parents sleep together, and though they want the non-gestational parent to spend the entire childbirth time WITH the parent giving birth, they will not feed them. There are all sorts of weird details like that.
posted by jeather at 2:32 PM on March 25


As time goes on, I'm just waiting for something healthwise to go wrong. Haven't been to a doctor in about 10 years. Don't have insurance. My main fear is that I will get something that won't kill me swiftly, I'd rather die quickly than live a long time digging my poverty hole deeper and deeper by trying to pay for medical bills. On the bright side, I've seen nothing about the world that makes me think I should miss it or even want to continue being here so I'll stick around till I roll a critical miss and then I'm happy to retire my character sheet.
posted by GoblinHoney at 2:44 PM on March 25 [3 favorites]


American who studied abroad in Sheffield for a semester, I will never forget the time I accompanied my British housemate who had to go to the ER on St Patrick's Day after stepping on some glass. 100x more humane than the paperwork process at an American ER. That experience alone of culture shock that something so routine could be so drama-free was enough to make studying abroad worth it, and I still try to fish out my NHS card once in a while from my journal and caress it with care.

(My heart breaks when I hear stories about how the Tories are trying to make the NHS more like American healthcare, WTF!!!)
posted by mostly vowels at 4:26 PM on March 25 [1 favorite]


Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

I know a like, "i forget how many the actual number is" amount of other trans women who work at starbucks for the insurance. Some, like a good percentage as a second job entirely for that reason.

When i worked in a meh bank office job(where no one seemed to really be happy besides the senior people) i had several coworkers who were very clearly there for insurance, and left the instant another opportunity with similar coverage popped up

Multiple friends have semi seriously discussed marrying each-other so one could access the others insurance

I cried with joy after getting my new job when i realized the insurance was actually good


Honestly it's fucked up how much of a thing this is. When i was very first asking friends who worked at my new job about it one of the literally interjected to be like "oh yea the insurance is great too"
posted by emptythought at 4:42 PM on March 25 [7 favorites]


This has always been a horrible idea because every honest adult can easily conceive of the idea of a person who becomes too sick to work at all, to work full-time or to do the type of work that usually comes with insurance coverage.
posted by Selena777 at 5:51 PM on March 25 [3 favorites]


The economics on US health care cost are dismal - the high cost of medical care is partly a function of the massive administration costs that the private health insurance industry overlays on the functioning of the health care system, and make that double with HMOs who want to second guess/authorise every decision.

A friend in Australia wen to the Peter MacCallum Cancer Centre ("Peter Mac") and was asked, "Do you have private health insurance?". "No." "Well please don't get it, because this way we only have to keep one file for you - your medical records. If you have private health insurance, then we need to keep two files, and the financial records file usually ends up being larger than the medical records file."

So this is in Melbourne and the private health insurance funds are pretty closely scrutinised. In the US - not so much - so the systemic costs are brutal.
posted by Barbara Spitzer at 5:53 PM on March 25 [2 favorites]


I'm surprised that ancillary services and prescription meds aren't covered by provincial health plans. Physical therapy, antihypertensives, etc are what actually help people get better/reduce the risk of serious complications.
posted by basalganglia at 5:57 PM on March 25


And as a post-script - I am furious that private health insurers will partially reimburse "complementary" treatments such as homeopathy in Australia, but won't make it compulsory that you vaccinate. Which is further evidence that they are not quite on top of the "evidence-based medicine" that they are supposedly helping to deliver.
posted by Barbara Spitzer at 5:57 PM on March 25 [2 favorites]


Meds are in fact covered, to some extent, in Quebec. I forget the exact details of how much is covered but I believe there's about a $90 max per month to pay. It's all covered if you're in a hospital or, I think, any kind of govt care home (rehab etc). But since medical stuff is provincial, every province differs. (I know OFFICIALLY the flu shot here is charged for, but they've never even asked for me, I just show up and get a shot.)
posted by jeather at 6:08 PM on March 25


Phreesh: "The very best at everything (surgeons, researchers, specialists of any kind) tend to end up in the States where they can make way more money. If you want the BEST of anything, you need to go to the States. Our rich hockey players, actors and business leaders head down to the states for their medical care."

Thanks to the expanding xenophobia that trend is at least slowing down.

Besides in most cases the same same happens in the States where the best people are sought out by people with means and the best people tend to only be available in the largest population centres. Look at Steve Jobs who famously jurisdiction shopped for his treatments. The 1%ers are always going to be able to do this regardless of who is paying.

Phreesh: "That said, don't you think that's an awful lot? Don't you think that we could do better at curbing costs in a country with an ageing population?"

The costs don't seem unreasonable and taxes aren't burdensome IMO. If anything we should be spending more to give access to at least some drugs. Diabetic and high blood pressure treatments are two obvious places where treatment now is way cheaper than treatment later.
posted by Mitheral at 9:50 PM on March 25 [1 favorite]


At this very moment sitting next to my 14yo daughter who asleep in a hospital bed in Australia. She started coughing blood a week ago. In that time she has seen the GP 5 times, had an X-ray and blood tests at specialist rooms, presented to the hospital Emergency Dept and had another round of xrays and bloods done, been admitted to hospital in a single room, where I can stay with her, been given various drugs and tests.
My out of pocket expenses - $14 for the antibiotics the GP initially prescribed and $20 for hospital parking.
I do not buy private health insurance because having done the sums and weighed the risks, I cannot see the benefit to my family at this time, even with having to pay the extra 1% levy.
Having private health insurance, you pay 3 times, Medicare levy everyone pays, monthly insurance premiums, and the uncovered costs at the time of the illness. Under the public system, I just pay the Medicare levy plus 1% because of my income. People tell me you get the “extras” but everyone I know seems to be always desperately trying to use those extras that they have paid for - often not really needing them.
posted by jacanj at 10:01 PM on March 25 [2 favorites]


Death By 1,000 Clicks: Where Electronic Health Records Went Wrong - "The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess. Inside a digital revolution that took a bad turn."

also btw...
-Oscar: Who Runs That?
-Walmart is so desperate to fix health care, it flies employees to top hospitals in other states for treatment
-Canada Sees Its Biggest Influx of Immigrants Since World War I
-Canada is becoming a tech hub. Thanks, Donald Trump!
posted by kliuless at 12:12 AM on March 26 [2 favorites]


If you want the BEST of anything, you need to go to the States.

Rand Paul, of all people, would disagree - he came to Ontario get the best hernia surgery he could find.
posted by mandolin conspiracy at 5:41 AM on March 26 [5 favorites]


One particularly insidious feature of US healthcare/insurance is the slow boil of gradually declining coverage from employer provided health insurance which is effectively becoming an annual pay cut for almost everyone. Everytime your deductible goes up, that's your compensation being cut. Our deductible has gone up about every second year so far this decade.
posted by srboisvert at 5:58 AM on March 26 [4 favorites]


If you want the BEST of anything, you need to go to the States.

Rand Paul, of all people, would disagree - he came to Ontario get the best hernia surgery he could find.


Ah but the Shouldice hospital is a fairly unique private health care provider in Ontario. Canadians have to pay extra to use them. There are in fact complaints that Shouldice bills excessively for a simple operation including things like multi night stays for what is usually outpatient surgery in other hospitals.

So in many ways you could say that Rand Paul sought out the most American of possible treatments available in Ontario, Canada.
posted by srboisvert at 6:05 AM on March 26 [1 favorite]


Ah but the Shouldice hospital is a fairly unique private health care provider in Ontario. Canadians have to pay extra to use them.

For patients in Ontario, OHIP covers treatment at Shouldice (Canadians from out of province are on the hook for extra).

So in many ways you could say that Rand Paul sought out the most American of possible treatments available in Ontario, Canada.

To add to that - it went from being privately owned to being acquired by a publicly-traded company several years ago, so yeah, true. And its for-profit model demands higher billing for sure because the shareholders come before patients or the public good.
posted by mandolin conspiracy at 6:18 AM on March 26


Point being, public discourse in the US would have people believe that Canadians are trudging through the snow after an 18-hour day on the kolkhoz in order to wait in line for weeks in their scratchy woolen coats only to be roughly etherized and operated on with a pair of rusty pliers lest Americans realize the degree to which they're getting ripped off by private enterprise and a lack of universal health care coverage and decide to do something about it.
posted by mandolin conspiracy at 6:25 AM on March 26 [13 favorites]


And I like the argument that if the US would adopt a universal single payer system the rest of the world would have to up their game cause you can’t use “well at least it’s not the the nightmarish US system!” anymore
posted by The Whelk at 6:52 AM on March 26 [4 favorites]


I'm currently waiting nervously, in Toronto, for an appointment at "the good clinic" for a thing, and you may have my government health insurance when you pry it out of my cold dead hands. Never send me back to an HMO with copays and worries about in-network and losing my job/savings-draining COBRA, please.
posted by wellred at 7:48 AM on March 26 [1 favorite]


Ah but the Shouldice hospital is a fairly unique private health care provider in Ontario.

Nope. Most healthcare in Ontario is provided by private providers. It's theinsurance that's government, not necessarily the healthcare. So the private healthcare provider bills the government. It is illegal for them to bill the patient if the patient has provincial insurance and the procedure is covered by provincial insurance (i.e. you can't say "we'll do your surgery faster/better/with gold sprinkles if you pay yourself." If it's covered you have to just bill the provincial insurance and that's it. So most patients at Shouldice are from Ontario and all of those Ontario patients have their surgeries (and examinations and tests) covered by OHIP.

Also, private doesn't mean expensive or exclusive. The other big private hospital in Ontario is Toronto Grace which has a special mandate for the poor and isolated.

What I think would maybe blow Americans' minds is that in all those experiences, I only had to submit paperwork for the physio.


This. I mean healthcare in the US isn't just expensive, inaccessible, inequitable, and lacking in choice, it's also so MUCH WORK. In Canada there are no bills, no statements, no pre-approvals, no deductibles, no copays. You just walk into the doctor's office and you walk about of the doctor's office. Other than the health history when you see a new specialist, there's no paperwork. There are no statements in the mail. Nothing.
posted by If only I had a penguin... at 8:11 AM on March 26 [3 favorites]


“the @curaffairs team made me realise: many Americans don't like the idea of 'government' healthcare, because they don't like dealing with bureaucrats. But in my 20+ years on the NHS, I've never talked to a person about my healthcare that wasn't a doctor, nurse or receptionist.” @ambientgillian
posted by The Whelk at 8:46 AM on March 26 [6 favorites]


wellred: "Never send me back to an HMO with copays and worries about in-network and losing my job/savings-draining COBRA, please."

The "in-network" thing one of the shocking things for this Canadian. It seems I trot out this probably not unusual for Americans story every time we are talking about healthcare in the US but here goes again: I was down in the States storm chasing when one of my travelling companions passed out and collapsed in a convenience store. He came to just as an ambulance was getting there and one of the first things the attendants asked was "Which hospital do you want to go to?". To which every Canadian would think "WTF? The closest one dude!" but because of networks in the US is a vital question for the patient to ascertain the answer to.
posted by Mitheral at 8:53 AM on March 26 [2 favorites]


He came to just as an ambulance was getting there and one of the first things the attendants asked was "Which hospital do you want to go to?". To which every Canadian would think "WTF? The closest one dude!"

Ah, but Republicans tell us that because of high co-pays, healthcare consumers have "skin in the game" and will get three bids before selecting the most cost effective treatment facility. That's the way capitalism works.
posted by JackFlash at 9:12 AM on March 26 [1 favorite]


This has always been a horrible idea because every honest adult can easily conceive of the idea of a person who becomes too sick to work at all, to work full-time or to do the type of work that usually comes with insurance coverage.

This really is one of those ideas that has real mass support from the people.

Like, my dad is a highly skilled architect with a long career history. Now he's stuck working a tiny few hours a week in a hospital recycling/equipment department so he doesn't get kicked off of medicaid or ssdi. How the fuck does that serve society?

I know people like this in their 20s even, who honestly have tons of useful skills, often especially as artists. If the system was just, they wouldn't have to worry about getting care or housing and could focus on... actually doing the things they're good at and/or enjoy.

Capitalism is hilariously inefficient
posted by emptythought at 9:24 AM on March 26 [4 favorites]


I just came back to my office from a standing-room-only talk for Jonathan Metzl's new book, Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland. (Have never before been to a book tour talk that has made me want to leave work early and buy the book!)

Anyway, one of the features of the book -- and what he focused the talk on, this being a healthcare audience -- was a series of focus groups he did with lower-income white men around the time the Affordable Care Act was being debated and enacted, and the rhetoric these men, many of whom were actively dying of preventable diseases, were using to explain why they didn't want healthcare reform. (Spoiler alert: it was racism.)

One of the most striking statistics was that the lack of Medicaid expansion in TN cost white Tennesseans an average of 3 weeks of life lost. More for poorer folk, less for richer folk, but still. All comers, three weeks. (I suspect the numbers were worse for black Tennesseans, but that wasn't his research focus.)

And when he would say this, as part of these focus groups, when he would point out that "hey Mr. Jones, this bill means you could see the doctor for free* and get free/low-cost treatment for your COPD" or whatever, Mr. Jones would respond "Yes, but I'd rather die a month earlier than give an inch to the Mexicans and welfare queens." Apparently the "Mexicans and welfare queens" theme came up a LOT.

Basically, it was really depressing to realize that no version of universal healthcare** will come to pass in the US because red-staters would rather die -- literally -- than stop being racist.

* At the point of care
** The ACA did start off as a universal healthcare bill, but was so fundamentally crippled by the Tea Party/GOP that it turned into "render unto the insurance companies" rather than truly expanding access; and even the very basic provisions of no pre-existing conditions and preventative coverage are again under threat. Make no mistake, they are pissed off because this is the legacy of the first black president.
posted by basalganglia at 11:27 AM on March 26 [12 favorites]


To which every Canadian would think "WTF? The closest one dude!"

Clearly, you do not work in the National Capital Region, where the prevailing wisdom is that if you get injured in Quebec, you should crawl across the nearest bridge before calling an ambulance for fear you might end up in a Gatineau hospital.
posted by jacquilynne at 11:33 AM on March 26


Ah but the Shouldice hospital is a fairly unique private health care provider in Ontario. Canadians have to pay extra to use them.

And btw, this -- at least the first half -- is what Rand Paul says and the whole thing is what he wants you to believe, and it really makes me angry that U.S. journalists don't seem to have fact-checked this or pushed back on it. This is one of the many private medical facilities in Canada that accepts provincial health insurance where residents of the province are treated for free and can have the exact same surgery Rand Paul had for free. He paid for what I could get for free. I don't get why U.S. journalists couldn't do simple Google and call him out on his bullshit.
posted by If only I had a penguin... at 11:58 AM on March 26 [5 favorites]


I have a new job starting soon.

I'm seriously considering switching from married-filing-jointly to married-separately, and possibly moving out, so that my husband and adult kids can continue to use the ACA while I pay ~10% of my gross income for single-person medical insurance, and also get hit with likely 30-40% withholding rates. Because I think that's cheaper than what'll be available if I cover the four of us through my work insurance.
posted by ErisLordFreedom at 2:36 PM on March 26


And I like the argument that if the US would adopt a universal single payer system the rest of the world would have to up their game cause you can’t use “well at least it’s not the the nightmarish US system!” anymore

We also would lose access to "we can't privatise that, it'd be taking us closer to American-style healthcare, do you want American-style healthcare?" so it's mostly a wash.
posted by Merus at 3:42 PM on March 26


If only I had a penguin...: "Most healthcare in Ontario is provided by private providers."

BC too. EG: If you aren't in some sort of institution (and many times even then) your family doctor is going to be a private provider.
posted by Mitheral at 9:03 PM on March 26


I am an American living in Taiwan with residence status, so I contribute to the NHI compulsory health insurance here. The sense of security I feel having socialized healthcare is essential to my mental well-being. Over time this has caused me to become increasingly outraged at the moral and ethical disaster that is healthcare in the USA.

There is no compelling reason why the USA could not implement healthcare for all. If diplomatically marginalized, economically stagnant Taiwan can provide stellar health services for everyone - including job-stealing immigrants like me - then the richest and most powerful nation on Earth could do it too.
posted by Enkidude at 9:59 PM on March 26 [2 favorites]


MEANS TV promo spot with Streetfight Radio “how afraid are you of getting an injury and how much would that fuck uo your life?”
posted by The Whelk at 5:34 AM on March 28


We also would lose access to "we can't privatise that, it'd be taking us closer to American-style healthcare, do you want American-style healthcare?" so it's mostly a wash.

Another problem for the rest of us: America attracts the most avaricious doctors from around the world. If you're a doctor who wants to make thousands for stopping by the bed of an out-of-network patient and saying, "Looks fine to me!", America is where you go. If the U.S. were to eliminate those abuses by moving to free healthcare, more of those doctors would say in their home countries and find ways to make the systems in their home countries worse.
posted by clawsoon at 6:39 AM on March 28


Another problem for the rest of us: America attracts the most avaricious doctors from around the world. If you're a doctor who wants to make thousands for stopping by the bed of an out-of-network patient and saying, "Looks fine to me!", America is where you go. If the U.S. were to eliminate those abuses by moving to free healthcare, more of those doctors would say in their home countries and find ways to make the systems in their home countries worse.

Weirdly, all the incredibly wealthy doctors I know who do this are white American men. Most of the immigrant doctors I know work in primary care. This report suggests that my experience is born out by the data:
More precisely, this report examines foreign-trained doctors in Primary Care Service Areas (PCSAs) and analyzes the socio-demographic characteristics of the populations they serve (see Methodology). For instance, it finds that:
-In areas with the highest poverty rates—where more than 30 percent of the population lives below the federal poverty rate—nearly one-third of all doctors are foreign-trained.
-Where per-capita income is below $15,000 per year, 42.5 percent of all doctors are foreign-trained.
-Where 75 percent or more of the population is non-white, 36.2 percent of the doctors are foreign-trained.
-Where 10 percent or less of the population has a college degree, nearly one-third of all doctors are foreign-trained.
...
For example, the Chicago Council on Global Affairs found that “native-born physicians are choosing more lucrative specializations, such as dermatology, obstetrics, and orthopedics. This leaves generalist positions like family medicine, internal medicine, and pediatrics more likely to be filled by foreign-born practitioners.” This reality is leading to severe shortages of critical primary-care, pediatric, and family medicine physicians in the rural areas of the Midwest and elsewhere.
posted by hydropsyche at 9:01 AM on March 28 [2 favorites]


International Profiles Of Health Care Systems (pdf)
This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.
Nixon's Plan For Health Reform, In His Own Words - "In 1974, President Nixon proposed universal health care, financial assistance for those who needed it and a way to control costs - a plan strikingly similar to those on Capitol Hill now."
posted by kliuless at 7:47 PM on March 28


Update on health insurance companies - in Australia the GOVERNMENT has now told them that woo-woo therapies are no longer acceptable as medical services.

https://beta.health.gov.au/resources/publications/private-health-insurance-reforms-changing-coverage-for-some-natural-therapies
posted by Barbara Spitzer at 10:18 PM on March 28 [1 favorite]


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