Insurance companies cooking up ways to standardize cancer care:

1Athena1

Question for Canadians: can doctors opt out of the national system and only take patients who pay privately? I know this does happen in England. You can only do it if you are quite at the top of your game. But this is an existing option - right?

crazy4carrots

Athena, there are certain procedures that docs can provide privately, such as cataract surgery, plastic surgery and some orthopaedic procedures among others.  Like chiropractors for example, these surgeons own and operate their own clinics.  For procedures which are covered (plastic surgery for vanity purposes* is not covered) the docs bill the government and are re-imbursed according to the fee schedule, but then charge their patients an extra fee.  However, the system is unlike England, in that "nominally" there is not a public stream and a private stream.

There are variations among the provinces, however; I'm only speaking of Ontario. 

*unless the surgery is for restoration, e.g. breast, facial etc. due to illness or accident. 

Beesie

Athena, I believe that some types of doctors have the right to opt out but it's rarely done. There simply is not a large enough private market. I know that some services are available through the private market - for example there are a handful of healthcare companies that offer high end general practitioner services.  The primary users of these services are corporations who offer this as a perk to their top executives. Similarly, a limited number of tests are available privately. You can get a colonoscopy through the public system or you can pay for one at a private clinic.  I believe however that the types of services that can be offered privately is very restricted and the number of physicians who can opt out is also very restricted.  As an example, I don't believe it would be possible to be treated for breast cancer privately, using a surgeon and oncologist who have opted out of the system.  I don't believe that doctors who offer those types of critical care services are allowed to opt out.  But I could be wrong so if anyone knows differently, please correct me. 

Here is more than you would ever want to know about the Canadian healthcare system:  Canada Health Act Annual Report 2010-2011 

1Athena1

Beesie and Lindasa, thanks. That's what I thought. It's like England. The salient point here is, one CAN have purely "private " care in universal single payer systems. As Beesie notes in Canada, I don't think it would be possible to go entirely private (no insurance) with cancer care in the US either - there simply wouldn't be enough of a market. I do go private with my comorbidity because the top practitioners in that field usually don't take insurance. But a psychiatrist, even in private pay, is miles cheaper than a physician who offers procedures like chemotherapy or surgery. PCPs, Internists and OBGYNs in the US also go private if they are good enough. This probably only happes in large metropolitan areas.

I once say an endocrinologist paying privately - but he did take insurance as a PCP. In England doctors themselves can offer patients treatment either through the NHS or private pay. For example, non emergency surgery can be scheduled sooner if the person pays privately.

The take home point is, we are all born and raised and treated in a free world in these countries. In Canada and the UK, you have the choice of

1) paying out of pocket for many services if you so loathe the government. :-) (Although some docs work in both systems)

2) Going through the single payer system

3) Choosing no care at all.

In the US you don't have such freedoms if you are one of the 50 million uninsured. ERs are NOT a substitute.

I like choice. Universal coverage gives me choice. I don't have to die or go bankrupt. Or rely on charity. Or go to debtor's jail - you don't believe me? As scootaloo for the link to a story of an illinois woman with BC. Some states will put non payers in jail.

Beesie

Athena, I wouldn't say that the Canadian system is at all like the UK's, at least from my understanding of the UK system.  I believe that they have a strong thriving private system that parallels the public system, offering the same services. In Canada we have only a very limited overlap of services offered in the public and private systems.  Most Canadians probably don't even know that there is an opportunity to go outside the public system for some services offered within the system - and relatively few would ever want to do that anyway.   

Canada does have a mixed private/public system but the distinction is that most of the services available in the private system are services that are not funded by the public system.  So many doctors offer both publicly paid and privately paid services, but these are different services.  A plastic surgeon does breast reconstruction on the government dime but breast enhancement surgery must be paid for privately by the patient.  There is one important point to understand that might help clarify this.  Doctors are not government employees.  They operate in private practices or work for privately funded hospitals, just as they do in the U.S..  For services that are covered by the government (mostly those that are deemed to be medically necessary), they bill the government. For all other services (mostly those that are deemed to be discretionary), they bill the patient.

As an example, if I go to see my dermatologist, as soon as I enter the office, her receptionist will ask for my health card and will scan it.  During the appointment, let's say that I have the dermatologist look at a skin rash and I also get a botox injection into my forehead (this is hypothetical, of course!).  Before I leave the office, I will have to pay for the botox injection. However the examination of the skin rash never hits my bill - it is charged directly to the government.  Similarly, as I mentioned in an earlier post, basic vision tests (for adults) are not covered by the government but anything related to eye disease is covered.  When I go to the eye doctor, I have a basic vision test and then I get a bunch of tests related to glaucoma - my eye pressure is checked, I have a visual field test, various other things.  When I leave, I receive a bill for the vision test ($95 last time); the other tests are all charged to the government.  Even at the family doctor there can be a split of the fees.  If your kid receives a medical form that must be completed by the doctor before she is allowed to go to summer camp, that's something you have to pay for privately. But most basic health services done by family physicians are covered by the government.  One other very important point - for many (probably most) basic healthcare and critical services, the fee is fixed by the government (through negotiations with doctor's groups) and doctors are not allowed to charge more.  

So what you have is in effect a private system where some services are billed to and paid by the government and other services are billed to and paid by the patient. Most doctors' practices are split between the public and the private, either because some of what they do is not government funded (family doctors filling out medical forms) or because they choose to focus on discretionary procedures (many dermatologists and plastic surgeons heavily promote their 'vanity' services). 

It used to be that the lists of publicly funded and privated funded services had no overlap - this was actually written into the healthcare legislation. However in recent years, as the baby boomers are hitting the system and requiring more and more tests and procedures, the government has been opening the door just a crack to allow some publicly funded procedures to be paid for privately. There was a court case in 2005 that triggered this, leading to more opportunities for private care in situations where the government is not able to provide timely care, i.e. services for which there are long waiting lists. This is what led to the availability of services such as colonoscopies within a fully privately-funded system. However another outcome of this ruling was that the provincial governments (healthcare is mandated federally but run by the provinces) started to very closely manage wait times for critical and urgent care, in order to ensure that these services are always available within an acceptable timeframe. As long as they do that, they do not need to open these types of services up to the private system. Both in the court ruling and through these government actions, great care has been taken to ensure that for critical services, there is no opportunity for the wealthy (or anyone with good supplemental insurance) to jump the queue or buy (or pay more for) the services of 'better' doctors.  This is in keeping with the "universality" and "accessibility" criteria of the Canada Health Act:

• Public administration: each provincial health care insurance plan must be administered on a non-profit basis by a public authority, which is accountable to the provincial government for its financial transactions.
• Comprehensiveness: provincial health care insurance plans must cover all "insured health services" (hospital care, physician services and medically required surgical dental procedures which can be properly carried out only in a hospital).
• Universality: all residents in the province must have access to public health care insurance and insured health services on uniform terms and conditions.
• Portability: provinces and territories must cover insured health services provided to their citizens while they are temporarily absent from their province of residence or from Canada.
• Accessibility: insured persons must have reasonable and uniform access to insured health services, free of financial or other barriers. This condition is emphasized by two provisions of the Act which specifically discourage financial contributions by patients, either through user charges or extra-billing, for services covered under provincial health care insurance plans.

PRIVATE HEALTH CARE FUNDING AND DELIVERY UNDER THE CANADA HEALTH ACT

And more from this report: 

Canada has a predominantly publicly financed, privately delivered health care system (...) Known to Canadians as "Medicare", the system provides access to universal, comprehensive coverage for medically necessary hospital and physician services as stated in the Canada Health Act.

Canada does not generally have a system of "socialized medicine", with physicians employed by the government. Rather, most physicians are private practitioners who work in independent or group practices and enjoy a high degree of autonomy. (...) Other providers (e.g. nurses, dentists, pharmacists, etc.) work in a mix of private not-for-profit, private for-profit and public delivery settings.

Most Canadian hospitals operate as private not-for-profit entities run by community boards of trustees, voluntary organizations or municipalities. However, the services within hospitals (e.g. pharmacies, food preparation, facilities maintenance, etc.) are provided by a mix of private for-profit, private not-for-profit and public sectors. Certain publicly financed extended health care services (e.g. continuing care programs) are also subject to a mix of public and private delivery mechanisms, with increasing emphasis on private for profit delivery of public services.  

crazy4carrots

Most Canadian hospitals operate as private not-for-profit entities run by community boards of trustees, voluntary organizations or municipalities.

This is a confusing statement, making it sound as though hospitals are privately (or corporately) owned, as many in the U.S. are.  To clarify, there are very, very few hospitals which are private; they are government-built, owned and funded, although each has a community Board of Trustees that "governs" the running of the facility.  Most also have a foundation, charged with raising funds for new equipment and programmes.

There is one very serious problem, and that is that there are still not enough rehab or complex continuing care facilities to accommodate patients who no longer require acute care but are taking up bed space in hospital.  This is one important reason why our elective surgery waiting times are longer than they should be.  It's also why the government has allowed certain elective surgeries (arthroscopy, plastics, cosmetic, cataract, for example) to be done in private clinics -- it eases the public system.

There are certain sacrifices (small though they may be) to be made in order to ensure universal coverage.  

A positive note:  I just read in today's paper that the federal government is planning to re-imburse caregivers who need to cut down their employment hours, or indeed resign their job, in order to care for a loved one.

1Athena1

No Beesie - I didn't mean public-private as in the Aussie system, for example. I mean that even in 100 percent universal healthcare systems, market forces exist to enable a few top private practitioners, willing payers and private insurers. I wanted to make this point -with your help- to counter assertions that a single payer system would not have a 100 percent "crowd-out" effect on private markets. But as you say it would be for limited specialties. I doubt whether a doctor could offer ONLY private cancer care - but of course people do pay privately if they are foreigners. 

 As Lindasa's post shows, a single payer system needn't get in the way of research either. In fact, the US federal government already subsidizes an enormous amount of research done here, which is good.

leggo

I can give you a recent example of private/for profit vs. public. There are two private, for-profit diagnostic facilities in my city. (I'm going to keep my opinions on this to myself however). My onc recently ordered a STAT CT scan and I would have had to wait three weeks for it to be done in hospital. I was sent to the private facility and still did not pay a dime. Now I don't know the details of how it was billed etc., but I do know that it didn't cost me a thing. Another lady there, did have to pay a $2400.00 bill. I have a feeling our government is mandating that the private clinics contribute when necessary and accept payment from them in order to be allowed to exist. Don't know if that is how it works...but my point is I got the CT when I needed it, even though it wasn't through the regular universal healthcare channels. I'm extremely grateful that our system allows someone to get what they need when they need it. I sit in awe sometimes of how well our system works.

Beesie

Athena, I think that you are stretching the point I made and taking it in a direction that is not accurate. As far as I know, most if not all of the top cancer specialists in the country operate solely within the public system for any services which are publicly funded. So even someone who is willing to pay a lot of money is not able to buy the services of the top doctors, or jump the queue and get in ahead of anyone else.

I was treated at the leading cancer hospital in the city.  My surgeon was their head of BC surgery, and my PS was considered one of the best for reconstruction in the city - she does not have a separate private practice and she does not do any vanity surgeries. Celebrities and media personnel and other doctors and the "1%" pretty much all go to the surgeon and PS that I went to, or one or two others in the city.  During the time of my treatment, at one time or another I spotted in the waiting room pretty much every known personality who was going through BC treatment at the same time I was.  There they were, waiting for the same doctors in the same waiting rooms.  No special treatment, no extra money being spent to get care at a private facility, none of that. 

The key point about the Canadian system is that while we have 100% universal healthcare coverage for basic care and critical care, we do not have 100% universal healthcare coverage for all medical needs. So there is a private system for those services not covered by the public system. In recent years, with the pressures on the government system because of baby boomers, some selected tests and services covered by the government (CT scans, to Gracie's example) can now also be purchased through private providers.  But that is restricted and it's a small part of the system.  (Gracie, my guess is that the other woman had to pay for her CT scan because it was something she wanted rather than something that she needed as part of a diagnostic or disease management process.)

As for the relevance to the U.S. system, I don't think it's fair to assume that anything about the Canadian system - good or bad - would be the same if there were to be universal healthcare coverage in the U.S..  Every country sets up their own way of doing things so there is no way to know how a U.S. system would work. I got into this discussion about the Canadian system simply to correct misstatements that were being made about the Canadian system, not to use Canada as an example of how a future U.S. system might work.  I don't have a clue how a future U.S. system might work. 

Linda, thanks for the clarification on the hospital point. The Canadian hospital system is confusing. Provincial governments do have control over hospitals - they decide which hospitals open and close - and they provide the operational funding, but within the hospital, operations are managed by private or municipal boards. I think that anyone visiting a hospital in Canada would be hard pressed to notice any differences vs. hospitals in the U.S.. Canadian hospitals have wings and special units that are paid for by and named after philanthropists and corporations.  Just like in the U.S., every piece of equipment and room seems to have a plaque attached, with the name of the sponsor or whoever gave the donation to fund the purchase.  Thinking only about breast cancer facilities at Toronto hospitals, Mt. Sinai has the Marvelle Koffler Breast Centre, PHM has the Campbell Family Institute for Breast Cancer Research, TGH has the Belinda Stronach Chair in Breast Cancer Reconstruction, Sunnybrook has the Odette Cancer Centre.  It's exactly what you would see in the U.S. (with my elderly parents living in the U.S., I've spent too much time in recent years in U.S. hospitals). Canadian hospitals are a good example of the public and private sectors working together, which really is what the Canadian healthcare system is all about.... the private sector providing medical services that are funded and guided by the government. 

1Athena1

Beesie, I think we are manufacturing a disagreement that doesn't exist - LOL! I understood what you meant. My point, again, was to argue against misconceptions that exist in the US.

As far as I know, most if not all of the top cancer specialists in the country operate solely within the public system for any services which are publicly funded.

I agreed with that twice.

Getting back on track, a person has lots of choices in a single payer system.

kayfh

Beesie, I want to have you on my side. No matter what the issue. Your explanation of the Canadian system is spot on. And I agree, we, in Canada have a good system. Not perfect, but it works for us and for immigrants and refugees who come to our shores. We don't have the only way to do things, but we have a way that seems to work fairly well for most of us.

Mardibra

Out of curiosity, what are some examples of how the system differs between provinces?  Im trying to figure out how each indiviual state in the US might apply the same rationale if we end up with universal healthcare.

leggo

I'm not sure how things differ from province to province by I'll give you some information on mine. Maybe others can jump in with differences in their's.

All government funded health care is provided through a provincial health card containing a number and your name. This card is issued at birth. It's shown each time you receive medical care of any kind and prescriptions. It is renewed every five years. You don't have to do anything or fill out anything....the renewal comes automatically in the mail. It really is just that easy....you show your card, get your consult and treatment and walk in and walk out. Never a need for paperwork from the patient. This card is used for everything and the number must be given to schools in case your child needs medical attention so that the number is on record. It needs to be shown only once in the case of cancer treatment. Once they have it on record you don't even have to bother showing it anymore.  It is the second most common form of identification, next to a driver's license.

The following is provided at no cost:

any doctor's visit - sometimes a small fee is charged for filling out forms for employment etc. the fee usually runs between $25 and $50, depending on the doctor. My family physician, however, does not charge for this service, but some do.

any specialists visit - you must however, be referred by your family physician. You can however, have your choice of who you would like to see. I usually go with whom my physician picks....he knows who's good and who's not.

any diagnostic service - x-ray, CT, MRI, mammo etc.

hospital stays - unless you request a private room...then you will pay, anywhere from $75 to $125, depending on the room.

ER visits - including all diagnostic services, treatments and medications.

annual eye exams for anyone under the age of 18 - after that age you will pay for an eye exam anywhere between $90 and $125, depending on the optomotrist.

all cancer diagnostics, treatments and medications - not wigs but employers reimburse

Now for the things that you pay for, keeping in mind that employee benefits usually reimburse you for any of these charges.

ambulance/paramedic services - anywhere from $125 to $400 depending on distance. Air-lifts are usually around the $700 to $1500 mark.

crutches, splints, braces, casts - there is usually a nominal fee for these things, usually between $10 and $20.

hospital beds, walkers, wheelchairs - you give a deposit of between $50 and $500 for these items and the money is refunded to you when the item is returned.

Dental - it costs a fortune, nothing is covered...so thank gawd for employee benefits.

Prescription glasses/adult eye exams - also reimbursed through employee benefits programs, usually up to an annual maximum of $250

For people who don't have employee benefit programs, insurance can be purchased to cover all of these things for somewhere in the neighbourhood of $50 and $250 per month. The cadillac of plans will cover you for EVERYTHING, including any medical costs incurred on trips abroad.

The only thing I can't speak to is prescriptions. I am Stage IV and don't pay for any prescriptions, even if they are not cancer-related...antibiotics for instance. The rest of my family is healthy, so I have no idea what prescriptions cost, other than some morphine my son needed for kidney stones...we paid $16 for a two-week supply. Again though, depending on your employee benefit program you will either get the prescription for a nominal fee or be completely reimbursed. Most do the latter. My understanding is that most common drugs are covered under a prescription drug plan and are reasonably priced. It's the uncommon ones you will pay a higher price for. Most doctors are pretty good at prescribing the least expensive or the generic version of those.

If you are Stage IV, you don't pay for ANYTHING, except eye exams, eyeglasses and dental. Everything you may need is provided at no charge, including ensure/boost, hospital bed, wheelchair, walker, nursing visits, physio, massage, braces, splints.....anything. You also have the option of home-care coming on a weekly basis to help with cleaning/cooking at a nominal fee.  

I think I covered it all..if not I may be reminded when others post and can add more. I'm curious myself about the difference between provinces...I have no idea really...paying for healthcare is just never anything I worry about....I mostly take it for granted, but occassionally feel guilty about how much my illness must be costing the taxpayer. However, in the same light, if my government decides they need more tax dollars from me, I'm certainly willing to pay it. It's the right thing to do....nobody should be denied treatment because they can't afford it. The mere thought of that disgusts me. It's inhumane.

ETA: the most important thing....the sickest are dealt with first. So anyone who's bitching about wait times...I personally think they should shut-up. If you have to wait a few extra weeks, or even months for some mundane diagnostic or appointment with a specialist, it's because someone sicker needs it more. All physicians certainly know if cancer is suspected and if so they put a hurry on things. Critically ill patients will always come first and that's the way it should be. I myself have no patience for those who disparage our system because they've been waiting for six weeks for an MRI to find out why their shoulder is sore (just an example). I'm sure we'll be hearing some of those "horror" stories, but I'm not into it....I ignore them....they irritate me. If you are to wait an unreasonable amount of time, your family physician will ultimately refer you to another source (i.e. a hospital in another city, etc.) They don't just leave you hanging. You have options.

Beesie

mardibra,

Here are some of the differences between the provinces that I'm aware of:

- What's covered, what's not:  Other than basic medical care, hospital care and critical care which must be covered, each province gets to decide what's covered and what's not.  Dental and vision care do not need to be covered so each province determines the range of services that they choose to cover in these areas. For example, Quebec covers dental care for children under the age of 10 but Ontario doesn't.   

- Planning and funding of healthcare facilities:  Each province has their plan for how medical services are made available and they allocate their funds accordingly. For example, Ontario currently is trying to direct many smaller procedures and services away from hospitals and instead to clinics. As a result we are seeing private clinics popping up everywhere (they are private clinics but most of the services they offer are 'covered' services so the government is billed and the patient doesn't have to pay). To try to cut down on visits to emergency rooms, Ontario has set up something called TeleHealth, which is a 24-hour service that you can call to speak to a nurse. I used it one time, speaking first to a nurse and then to someone with more knowledge about my particular concern.  A 10 minute phone call eased my mind and saved me a trip to the emergency room.  Every province develops their own plan for how to ensure that everyone has access to medical care.

- Private services: Each province has their own list of which 'covered' medical services can also be offered through a pay-for-service private system.  Some provinces are more open to this and have longer lists of available services while other provinces are more restrictive.

- Drug Coverage: Although drug approvals are handled federally by Health Canada (our version of the FDA), once a drug is approved, each province gets to decide if and when the drug is put on their formulary. Usually only drugs that are on a province's formulary are covered by drug plans in that province. Most approved drugs eventually get onto the formulary of all the provinces but it may take differing amounts of time.  A recent example of this was Herceptin, which was added quickly in some provinces and more slowly in others.  

- Drug Coverage:  Each province decides whether and how they will cover out-of-hospital drug costs. In Ontario, we have the Trillium program which allows anyone of any income to apply to have their drug costs covered by the government if their out-of-pocket costs exceed 4% of their income.  So even someone with a relatively high income can get coverage if they have extremely high drug costs (for example a drug that costs $40,000 a year). The plans in other provinces are different.

- Negotiation of Fees: Each province is responsible for negotiating with the medical associations in their own provinces and for setting the fees for services in their province. 

- Healthcare taxes or fees: The federal government transfers funds to the provinces to cover healthcare costs but in addition to this each province has the right to charge a healthcare tax or to implement user fees. In Ontario, we have a Healthcare Premium added onto our taxes.  It starts at $60 for those with taxable income (not gross income) of $21,000 and goes up to $900 for those with over $200,600 in taxable income.  Some provinces charge a tax, others don't.  I don't think any have user fees -it's quite controversial - although personally I think a nominal user fee ($2 per doctor's visit, for example) would be a good way to generate much needed revenue.

Those are the differences that I can think of off the top of my head.  Each province must have a healthcare program that delivers to the 5 criteria in the Canada Health Act: Public Administration, Comprehensiveness, Universality, Portability and Accessibility.  How they achieve each of these 5 criteria is up to the them.  And what they do beyond those 5 criteria is up to them.  So there is a lot of flexibility and that leads to a lot of differences between the provinces.

Personally I wish that there was more standardization.  For example, when a drug like Herceptin is approved by Health Canada, I would like to see it mandated that the drug has to go onto the formulary of every province. I'd like to see the same coverage for children and seniors across the country. I'd like to see the availability of drug coverage programs like Ontario's Trillium program across the country.  But that's not going to happen.  I think there are some good reasons to allow the provinces as much freedom as they have to develop their own programs, but I don't think it's the best thing overall for patients because inevitably some will be shortchanged on services they need, just because of which province they live in. 

crazy4carrots

There are a couple of important factors to consider for our U.S. friends who think universal healthcare might be a good idea:

The first is "portability".  I recall twin teenage boys from Newfoundland who frequently travelled to Toronto for cutting-edge treatment at the Psoriasis Clinic at Women's College Hospital.  It wasn't available in St. John's, but the Nfld Ministry of Health covered their expenses for tx in Ontario.  And if a patient requiring specialized tx not available in Alberta, for example, needs to travel to another province where it is available, her costs are covered, including travel and accommodations.

The second is about the "government" deciding on what gets covered and what doesn't.  Perhaps the case of an Ontario patient with a small Her+ (less than 5mm) tumour made her case known to the public because the current Standard of Care was no herceptin for tumours her size (and this was based on the accepted research studies available to Cancer Care Ontario.  The Ministry of Health and Long-term Care looked into and instructed CCO to change the standard, backed up by more recently published studies.

I state this because I believe it is much easier to influence the "government" -- you know, the folks who you elected and who work for YOU -- than it is to influence a health insurance behemoth, whose only criterion is making as much profit as possible, by trying to deny payments for healthcare! 

Beesie -- an EXCELLENT rundown, as usual!!! 

Mardibra

Great info. Thanks!

leggo

Linda, good point that never crossed my mind until I read your post. The "portability" is a huge factor. I completely forgot about my friend who had to travel cross-country for a certain liver disease and eventual transplant. Didn't cost her anything. The accomodations for her family however, had nothing to do with our healthcare...the tab was picked up by the hotel.

Kaara

Sadly, any kind of universal health care system in the USA would have to get past the insurance lobby which is a powerful mechanism that makes sure nothing like this ever happens.  The result of any attempts is what we now call Obamacare, a botched mess that gives the insurance companies the leeway to continue to screw with our pocketbooks.  I can only imagine what will happen to cancer patients if we get "standardized care".  Right now, I pay out of pocket to get treatments that insurance will not cover, treatments that are keeping me healthy rather than weak and debilitated.  I choose that because I don't believe the "standard of care" that is being offered for my early stage low grade bc is right for me.

All the items talked about on this thread were included in the original insurance reform package put forth by our current administration, and it was systematically taken apart by the lobbyists and special interest groups that work for big insurance.  The leaders that we put in Washington are no match for these groups and are far too weak to stand up to them.  As long as we have these powerful groups controlling our politics, the average citizen is going to have no say in what happens with our health care system.  

crazy4carrots

Kaara:  You wrote:   I can only imagine what will happen to cancer patients if we get "standardized care".

Isn't that what you have right now?  Don't insurance companies follow "standardized care" in their decisions? 

From my "outside the USA" perspective, I think it will be small steps taken on the way to universal healthcare, much as Medicare and Social Security began.  The ACA is one such step.  Kaiser Foundation has an excellent rundown of the ACA -- worth googling.

By the way:  under our system, patients with life-threatening illnesses such as cancer go to the head of the line when it comes to treatments and tests. 

alexandria58

I was also for a single payer health care system, close to that of Canada, but am willing to settle for doing this in small steps, ie ACA.  I had neighbors here in the US who, after the husband lost his  job and they decided to open a restaurant, moved back to Canada to do it.  the husband had medical issues and trying to pay for insurance and care here in the US was far too expensive.  They've home in Canada, restaurant's doing well, and so are they.

 

SelenaWolf

I agree with Beesie... in Canada, additional health insurance is to cover those "extras" our government plan doesn't, like vision care/glasses, prescription drugs, dental care, physiotherapy, occupational therapy, etc.  Our government plan provides a basic standard-of-care medical coverage for everyone and most employers (mine included) provide the additional coverage as an employment benefit. 

In other words, I did not and have never purchased additional health insurance.  The only bill I have ever had to pay out-of-my-own-pocket in 51 years is a $45.00 ambulance bill twenty years ago.  In half-a-century, I have never paid a doctor's bill, a hospital bill, a pharmacy bill, a bill for screening/diagnostic tests, a bill for flu shots or vaccinations... or a medical/health insurance premium bill.  Between OHIP and both my husband's and my employment benefits, we're covered.  It's a good feeling... especially now.

Mardibra

Kara - as I understand it, you are paying out of pocket because you have chosen to use alternative treatments.



I have had insurance coverage for more than 25 years continuously. I pay approx $100/month plus co-pay's of either $10 or $20 depending on the service/specialty. Since my BC diagnosis. Have paid a grand total of $60 plus $3 here and there for prescritions. I have had mammo,s, MRI's, CAT scans, bone scans, 'MUGA scans, biopsy, lumpectomy, port insertion, 3 months of chemo, mastectomy, and am about to start radiation for 6 weeks. Not bad for approximately $1,200 bucks for the past year! I was able to choose any doctor I wanted...was not forced "in network". My BS, MO, and RO all work for a world renowned cancer institute. I have never waited more than a few days for an appointment, they spend lots of quality time with me during those appointments.



So, with all that said, why would someone in my situation think that the US Government would do better? No way...never going to happen. Certainly would not be cheaper. I will stick with what I have thanks.



I am a big proponent of small government....it's just my thing. I'm pretty sure that if the US Government got involved I would likely lose benefits, wait forever, and pay through the nose. Again, no thanks.



If I were someone with poor health insurance or, God forbid, no health insurance, I would be jumping up and down for national healthcare. But, there are more people with insurance coverage than without. As long as that is the case, I'm not hopeful for any sort of reasonable national healthcare.



Obamacare? It's a joke and a mess. Typical US gov't nonsense.



Sigh.

Kaara

mardibra:  As you wish....typical conservative...I'm ok but I don't care if you're ok because I'm living in my own little world and have everything I need.  Don't you live in Romney country?  Isn't that where the original idea for national healthcare came from?

Sigh! 

Mardibra

Gee, thanks for not caring.



Yes, I live in "Romney land". That doesn't mean I agree with national healthcare. I see that you live in Florida....does that mean you agree that Casey Anthony didn't kill her child? Does it mean that you agree with the "stand your ground" law?

Mardibra

I am not covered by any national or state run healthcare because I am covered by private health insurance. So, I do not "enjoy" Romney Care. As a resident of Massachusetts I am required to prove I'm covered by private insurance when I file my taxes each year. If I couldn't prove that I would be required to PAY for state healthcare.

Sommer43

I will clarify the UK health system, as there has been much speculation and mention of it in this thread. 

 On the NHS, there are doctors who practice within the NHS and in private practices concurrently.  A consultant who works in both the private and public sector, may well take a patient, on the NHS to a private hospital where he/she practices and tha patient will not have a bill at the end of it.   The NHS is available to all EU citizens, whether they pay taxes or not, all they have to do is apply for an NHS number.  It is not income based in any way shape or form.  Just like when I moved to another EU country, if I needed medical help, I could be seen. 

Private medical insurance, can be taken out by any individual.  The NHS, is the largest employer within the United Kingdom, is not without it's flaws like any large organisation, we, the public, are now being given more choices, where we can, not dissimilar to the Candian system, see any doctor, registered within the NHS in any part of the UK.  It has all been opened up with a fairly new system, called "Choose and Book" 

All General Practitioners, are the platform to access to any area of medicine.  They are the ones with the power to refer patients based on their findings, but once a referral is made, any patient can request a password from the GP and see any doctor they like via the choose and book system.    We are entitled, to a second opinion, third opinion and the NHS is not as restricting as the media would have the rest of the world believe.  Currently the NICE guidelines for referrals to breast clinics, are on a two week pathway.  Clinics have to see a patient within two weeks of first contact from a GP on a patient's behalf.  There are long waiting lists, for many places and certain hospitals have had bad press recently.  The NHS, like any health care system is a vexing topic.  But, from a cancer perspective, the treatment is up there with the best.  The only benefit from going private, is to omit long waiting lists, but a mammogram for instance, paid for privately, will still take a week for the results, that's a screening one, not a diagnostic one.

We have to pay for eye tests, but can, if on a low income, have help towards the costs of glasses, we have to pay for our dental check ups, unless again on a low income, whereby we can see a dentist who accepts NHS patients, but all children up till the age of 16, have free dental care, and over 60 years of age or 65 for men. 

If, we have to have chiropody for example, the waiting time on the NHS is long, or counselling and one will be awarded six sessions.  The mental health services are poor in my area, it takes some digging around to get somewhere.  It is a good system, with it's flaws, money driven, but one will receive treatment where required. 

Kaara

kayb:  Thank you....couldn't have said it as well as you did!

Mardibra

Plus, if I dont buy that state healthcare at more than $500/month, I would pay a $1,000 penalty each year to the state of Massachusetts.

crazy4carrots

kayb -- Does that explain why Mardibra pays ONLY approx. $1,200/year for health insurance?  That amount seems incrediby low!  I carry family supplemental health insurance (covering dental and all the other extras previously mentioned by Beesie) at just over $400 per month.  Will discontinue it when I turn 65 and our medicare kicks in.

Wabbit

Employer sponsored health insurance would explain mardibra's cost ... it is just a little less than what I pay.  (The employer is paying several hundred dollars a more each month on top of what the employee pays.)  Only mine is the FEHBP and that untrustworthy, sure to muck everything up government is running my health insurance program ... and they do it very well by the way.  Or that cost is also what Medicare costs ... another government run program. 

The thing people don't think about is that employer sponsored health insurance is purely available at the whim of your employer.  They decide it's gotten too expensive, they can drop it.  They go out of business, or you get fired or laid off, or you get too ill to work and it is gone in a heartbeat.  At that point you are up that well known creek without a paddle and wondering WTH happened.  I've seen it happen over and over and over again to friends and family who never saw it coming.

Anybody who thinks they are 'safe' ... other than maybe those on Medicare ... is under an illusion.

The ACA is modeled on the FEHBP which works very well for me.  I personally think single payer would be better for everybody but politically it is not going to happen until a critical mass of people get hurt very badly.  Sad but true IMO.