A Canadian experience with Canadian health-care

[rushmc 18]

Canada Health Plan May Deny 6,000 Surgeries

Wednesday, August 19, 2009 6:56 PM

By: Dave Eberhart Article Font Size




Vancouver, Canada’s health authority is mulling skipping over more than 6,000 surgeries in an effort to close a $200 million budget shortfall, according to a report in the Vancouver Sun.

The excised procedures would include a host of neurosurgeries, treatment for vascular diseases and other medically necessary procedures -- leaving patients waiting long periods of time for their backordered operations, said Canadian health critic Adrian Dix.

Dix pointed to a Vancouver Coastal Health Authority document he said outlined the cuts.

“This hasn’t been announced by the health authority … but these cuts are coming,” Dix said, citing figures he gleaned from an unpublished executive summary of “proposed VCH surgical reductions.”

The health authority confirmed the document is genuine, but said it represents ideas only. It is a planning document. It has not been approved or implemented,” said spokeswoman Anna Marie D’Angelo.

Canada's national health insurance program, often referred to as "Medicare,” is theoretically designed to ensure that all residents have reasonable access to medically necessary hospital and physician services -- on a prepaid basis.

Instead of having a single national plan, Canada has a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all framed by the Canada Health Act (CHA).

Roles and responsibilities for Canada's health care system are shared between the federal and provincial-territorial governments. Under CHA, criteria and conditions are specified that must be satisfied by the provincial and territorial health care insurance plans in order for them to qualify for their full share of the federal cash contribution.

Recently, the new president of the Canadian Medical Association said Canada’s health-care system is sick and doctors need to develop a plan to cure it.

Dr. Anne Doig argued that patients are getting less than optimal care.

"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," she told The Canadian Press.

On the Vancouver front, Dr. Brian Brodie, president of the BC Medical Association, called the proposed surgical cuts “a nightmare,” according to the Vancouver Sun. “Why would you begin your cost-cutting measures on medically necessary surgery? I just can’t think of a worse place,” he said.

According to the leaked document, Vancouver Coastal wants to close nearly a quarter of its operating rooms starting in September and to cut 6,250 surgeries. As many of 112 full-time jobs — including 13 anesthesiologist positions — would be affected by the reductions, the document indicates.

“Clearly this will impact the capacity of the health-care system to provide care, not just now but in the future,” Dix said.





© 2009 Newsmax. All rights reserved.

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[wmw999 2,122]

Fortunately private insurance companies never, ever deny any procedures that the patient's doctor considers to be necessary.

Being private enterprises, they don't have to share the numbers, though.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

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Fortunately private insurance companies never, ever deny any procedures that the patient's doctor considers to be necessary.

Being private enterprises, they don't have to share the numbers, though.

Wendy P.

Ya, them evil damn companies

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[wmw999 2,122]

No, they're not evil. But neither is the government evil, even the Canadian government. And, frankly, insurance companies are also not paragons of maximum efficiency.

NOTHING IS PERFECT. Right now there are millions of uninsured people in the country, with some pretty massive costs coming from that. Our current solution to that situation probably isn't perfect. And solutions that involve changing human nature probably aren't going to work, either.

Human nature says that people will try to get the most out of whatever system they have; that the operator of the system will try to get the most out of their system by covering as little as they can get away with, and human nature also says that people will continue to go to the ER if that's the only way to get medical help when they think they need it. And human nature says that we will not check for an insurance card before treating someone who's suffered an injury.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

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No, they're not evil. But neither is the government evil, even the Canadian government. And, frankly, insurance companies are also not paragons of maximum efficiency.

NOTHING IS PERFECT. Right now there are millions of uninsured people in the country, with some pretty massive costs coming from that. Our current solution to that situation probably isn't perfect. And solutions that involve changing human nature probably aren't going to work, either.

Human nature says that people will try to get the most out of whatever system they have; that the operator of the system will try to get the most out of their system by covering as little as they can get away with, and human nature also says that people will continue to go to the ER if that's the only way to get medical help when they think they need it. And human nature says that we will not check for an insurance card before treating someone who's suffered an injury.

Wendy P.

First off, the number of unisured is a bogus number.

Once the 12m illegals are pulled out and then those moving from one company to another or those that are young and choose not to be insured. The number is around 4m. And even those will get medical help if needed and we pay for it in the rates and prices we pay.

You want the cost of go up and to also lose freedoms, just get Uncle Sam more involved than he already is

The insurance companies are already highly regulated, both at the fed and state levels. Compitition is killed by closed states borders and state and fed mandates on what is coverd add to the costs.

let the insurance companies compete and offer more and varying types of plans (that they cant do today) and reduce court awards the prices will come down

This is the BEST health system in the world. Not perfect as you say but sure as hell not in a condition that we should pass it on to government.

And our governement, regardless of which party has the WH is nearing being evil. It will if we let it

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[georgerussia 0]

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First off, the number of unisured is a bogus number.
Once the 12m illegals are pulled out and then those moving from one company to another or those that are young and choose not to be insured.

This is one of things I emailed my Senator about. My understanding of the bill is that illegals ARE eligible for public option as well as for private insurance - however they will not get government credits (i.e. would be required to pay in full). Which, in my opinion, is a good thing, as otherwise they would just fill up the ERs as they do now.

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You want the cost of go up and to also lose freedoms, just get Uncle Sam more involved than he already is

The "lose freedom" part is the one I cannot understand. Could you please explain how adding another _insurance_ plan (note this is government-provided plan, not government-sponsored plan for everyone) would decrease competition? How does USPS existence leads to "losing freedoms"?

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let the insurance companies compete and offer more and varying types of plans (that they cant do today) and reduce court awards the prices will come down

I'm in USA only since 2005, and the only thing I seen was the rates going up. Somehow they never went down, so apparently this "competition" doesn't really work.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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The "lose freedom" part is the one I cannot understand. Could you please explain how adding another _insurance_ plan (note this is government-provided plan, not government-sponsored plan for everyone) would decrease competition? How does USPS existence leads to "losing freedoms"?

If the plan were entirely self sustaining, it would not be an issue, but it's not going to be because as with any gov't department, it doesn't have to be. At the same time, laws can be passed mandating and protecting it from it's own incompetence.

For a better example, look at something local, like education. Every taxpayer contributes, whether they have children or not. If a parent decides to send their children to private schools, they still have to pay their share for the public school, even if they are not using it. This puts private schools out of the reach of many that if they did not have to pay for the public school system they decided not to use they could apply towards private schools even if if was done on a reduced scale.

Ex.: Public school cost per pupil = $1000. If parents decided to use a private school, they'd get a voucher for $750.

It's the same with health insurance as people who are able to barely budget and afford private insurance now, will not be able to once the tax increases to pay for it hit. Once the private insurers start losing those people they'll need to raise their rates which will cause more to drop until private health insurance is out of reach of most if not all of the middle class.

We just went through and are still in the housing bubble where we saw what happened when we tried to make everyone a homeowner and how little effect all the gov't sponsored programs are doing to help the recovery. I don't have the stats but I'm guessing there are even less homeowners than before the whole thing started too.

If this passes, get ready for a health insurance bubble.

Hopefully some day we'll learn that giving to those who only take to try to bring them up to the level of those that contribute does nothing but bring the rest down.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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If the plan were entirely self sustaining, it would not be an issue, but it's not going to be because as with any gov't department, it doesn't have to be. At the same time, laws can be passed mandating and protecting it from it's own incompetence.

The problem is that all private existing plans are not self sustaining now, as they are allowed to deny coverage and kick people out, therefore shifting the burden to the government to pay for the healthcare for those who cannot get private coverage.

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For a better example, look at something local, like education. Every taxpayer contributes, whether they have children or not. If a parent decides to send their children to private schools, they still have to pay their share for the public school, even if they are not using it. This puts private schools out of the reach of many that if they did not have to pay for the public school system they decided not to use they could apply towards private schools even if if was done on a reduced scale.

Are you saying that before the government-provided public education became mandatory, the country was full of affordable and quality private schools? My guess is that quality private schools were ALWAYS out of reach for majority of the people, and were always only available to the minority which had money to pay for it. It is just common sense - the school could only handle limited number of students, so their fees should go up as long as there is enough student attendance.

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Ex.: Public school cost per pupil = $1000. If parents decided to use a private school, they'd get a voucher for $750.

You obviously understand that the end result would just be a private school making more money, not students saving money. See above; this would mean that each student could now pay $750 more, why not to cap those money? Why would a business pass its savings on the customers if it's guaranteed to sell all available space anyway?

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It's the same with health insurance as people who are able to barely budget and afford private insurance now, will not be able to once the tax increases to pay for it hit.

Sure, there will be some incentive to join the government plan. And I'd say insurers are to blame as well. Actually one of the reasons my insurer claimed when they raised the premium twice over two years was "Increased amount of uninsured driving up overall healthcare costs".

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Once the private insurers start losing those people they'll need to raise their rates which will cause more to drop until private health insurance is out of reach of most if not all of the middle class.

Why would they need to raise rates? Less insured people means less probability that they would have to pay for their treatment. You could see it right now - the premium rates charged by both small and large insurance companies are practically the same for the same coverage. There is also another option for private insurers - to provide better service, which will be more expensive, or they could provide cheaper service because they have more control about the costs (like Kaizer). Again, some people choose USPS, and some chose UPS, and last time I checked UPS wasn't bankrupt - even though it's obvious USPS is "stealing" their business.

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We just went through and are still in the housing bubble where we saw what happened when we tried to make everyone a homeowner and how little effect all the gov't sponsored programs are doing to help the recovery.

This is a completely different scenario; if you do not agree, I'd like to hear your rationale.

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If this passes, get ready for a health insurance bubble.

How do you envision it? Buy a health insurance for $100 today and resell it in a year for $200?

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Hopefully some day we'll learn that giving to those who only take to try to bring them up to the level of those that contribute does nothing but bring the rest down.

Again, we're already giving to them. It is just done in a different way - people go to ER, do not pay and the hospitals get bankrupt.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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If the plan were entirely self sustaining, it would not be an issue, but it's not going to be because as with any gov't department, it doesn't have to be. At the same time, laws can be passed mandating and protecting it from it's own incompetence.

The problem is that all private existing plans are not self sustaining now, as they are allowed to deny coverage and kick people out, therefore shifting the burden to the government to pay for the healthcare for those who cannot get private coverage.

While I do not not agree with some of the methods used, the fact is they are self sustaining plans.

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Ex.: Public school cost per pupil = $1000. If parents decided to use a private school, they'd get a voucher for $750.

You obviously understand that the end result would just be a private school making more money, not students saving money. See above; this would mean that each student could now pay $750 more, why not to cap those money? Why would a business pass its savings on the customers if it's guaranteed to sell all available space anyway?


But there is no guarantee as people now have a choice of which private school or stick with public. Some privates schools may cost far more than that $750, some may price themselves right at $750 and some may try and undercut or home school and give people back some of that $$$. As long as educational standards are met, what difference does it really make as the burden on the public system is reduced?

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It's the same with health insurance as people who are able to barely budget and afford private insurance now, will not be able to once the tax increases to pay for it hit.

Sure, there will be some incentive to join the government plan. And I'd say insurers are to blame as well. Actually one of the reasons my insurer claimed when they raised the premium twice over two years was "Increased amount of uninsured driving up overall healthcare costs".


This doesn't make sense. If one can't afford health care, how is providing them insurance they can't pay for going to lower healthcare costs?

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Once the private insurers start losing those people they'll need to raise their rates which will cause more to drop until private health insurance is out of reach of most if not all of the middle class.

Why would they need to raise rates? Less insured people means less probability that they would have to pay for their treatment. You could see it right now - the premium rates charged by both small and large insurance companies are practically the same for the same coverage. There is also another option for private insurers - to provide better service, which will be more expensive, or they could provide cheaper service because they have more control about the costs (like Kaizer). Again, some people choose USPS, and some chose UPS, and last time I checked UPS wasn't bankrupt - even though it's obvious USPS is "stealing" their business.


Less insured people means less paying in which means less to cover existing claims without dropping more people and/or raising rates.

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We just went through and are still in the housing bubble where we saw what happened when we tried to make everyone a homeowner and how little effect all the gov't sponsored programs are doing to help the recovery.

This is a completely different scenario; if you do not agree, I'd like to hear your rationale.


It's different but the underlying motive is the same.

Happy fluffy popular plan to try to provide something for everyone that does not make economic sense. Businesses sued and government mandated into providing and told the gov't will back them up and handle their losses. Now bulletproof, greed kicks in as short term risk goes to near 0.

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If this passes, get ready for a health insurance bubble.

How do you envision it? Buy a health insurance for $100 today and resell it in a year for $200?


Not health plans, health industry stock. If this passes it will skyrocket as the government will be paying for more services for more people. Health insurance companies will "pawn off" their preexisting condition people and those with large claims to the gov't while raising the rates on the existing customers as the now have less people to collect from. Health companies will merge into larger and larger conglomerates. People will make billions until the number of government insured people reaches a certain level and then the government deficit reaches a point where they have to start playing real "hardball" with what it pays for services. (procedures, prescriptions, etc.) As there is only a market for very few private hospitals and health insurance companies, most companies will be forced to comply and cut their own costs as well. This is where the rationing of care and the denial of service really starts.

Health companies would go bankrupt, only they've grown so large that they gov't can't let them so they're forced to bail them out and take part ownership.

If during any of this time large scale disasters or pandemics occurred...

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Hopefully some day we'll learn that giving to those who only take to try to bring them up to the level of those that contribute does nothing but bring the rest down.

Again, we're already giving to them. It is just done in a different way - people go to ER, do not pay and the hospitals get bankrupt.

Health insurance doesn't solve this issue, it merely passes the burden of paying the bill to someone else.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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While I do not not agree with some of the methods used, the fact is they are self sustaining plans.

Every plan could be self-sustaining if you are allowed to cherry-pick customers. The way those plans work right now is that as soon as you become too costly, the company forces you into the "government plan AKA ER/nopay" by dropping you. This is no different from a bank which gives bad loans and enjoys hefty profits, and as soon as the loan defaults, it dumps it on the government. Both such banks and such health insurance companies aren't benefiting the society; in fact they just create more burden.

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But there is no guarantee as people now have a choice of which private school or stick with public. Some privates schools may cost far more than that $750, some may price themselves right at $750 and some may try and undercut or home school and give people back some of that $$$. As long as educational standards are met, what difference does it really make as the burden on the public system is reduced?

So what is your point? Do you agree that despite having the government-sponsored education, we still have private school as an option (but this is really an option only for minority)? Are you saying that as soon as health standards are met, it should be matter of choice whether a person choses government or private health insurance?

Health insurance, however, is also different from for example auto insurance - everyone has some chance to become a public burden. With car insurance it's easy - don't drive, and you wouldn't have liability claims. With health insurance it is different - you might live healthy life, and then suddenly get brain cancer and require VERY expensive treatment.

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This doesn't make sense. If one can't afford health care, how is providing them insurance they can't pay for going to lower healthcare costs?

Easy. Treating sore throat, bad cold or a fever in a doctor office is cheaper than doing it in emergency room. Currently those who cannot afford healthcare, have only one treatment option - which is also the most expensive one. By providing them insurance they would be able to go to a doctor office, and we the taxpayers wouldn't be paying for them in ERs.

Preventive care is also important. This is not something uninsured could get in ER, and for a lot of diseases early detection decreases overall treatment costs dramatically, and often means less people to get infected from them.

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Less insured people means less paying in which means less to cover existing claims without dropping more people and/or raising rates.

Existing claims are supposed to be covered by premium already collected. An insurance plan which relies on future payments to cover existing claims is by definition not self sustaining, and is pretty close to Ponzi scheme.

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Not health plans, health industry stock. If this passes it will skyrocket as the government will be paying for more services for more people. Health insurance companies will "pawn off" their preexisting condition people and those with large claims to the gov't while raising the rates on the existing customers as the now have less people to collect from.

Did you read the bill? Insurance companies will not be allowed to deny coverage based on preexisting conditions, nor they will be allowed to dump insured. This was required exactly to prevent the situation you described.

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As there is only a market for very few private hospitals and health insurance companies, most companies will be forced to comply and cut their own costs as well. This is where the rationing of care and the denial of service really starts.

I do not understand this logic, as it assumes we'll suddenly get 40M more people to treat. We will not; those 40M uninsured are already receiving treatment, and that's why people have to wait 8 hours in ER to see a doctor. This will shift them from ERs to regular doctor offices, but I really do not see how it would significantly increase the amount of care.

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Health insurance doesn't solve this issue, it merely passes the burden of paying the bill to someone else.

No, it does - mainly because people now will go to ERs for _emergencies_, so the overall bill will be smaller.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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While I do not not agree with some of the methods used, the fact is they are self sustaining plans.

Every plan could be self-sustaining if you are allowed to cherry-pick customers. The way those plans work right now is that as soon as you become too costly, the company forces you into the "government plan AKA ER/nopay" by dropping you. This is no different from a bank which gives bad loans and enjoys hefty profits, and as soon as the loan defaults, it dumps it on the government. Both such banks and such health insurance companies aren't benefiting the society; in fact they just create more burden.

So is that totally the fault of the banks and insurance companies that the gov't takes the "bad" off their hands essentially rewarding this sort of behavior?

If the government didn't do that, the market would eventually sort itself out. Credit and insurance might not be as cheap or easy to get, but it would be available.

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But there is no guarantee as people now have a choice of which private school or stick with public. Some privates schools may cost far more than that $750, some may price themselves right at $750 and some may try and undercut or home school and give people back some of that $$$. As long as educational standards are met, what difference does it really make as the burden on the public system is reduced?

So what is your point? Do you agree that despite having the government-sponsored education, we still have private school as an option (but this is really an option only for minority)? Are you saying that as soon as health standards are met, it should be matter of choice whether a person choses government or private health insurance?

Health insurance, however, is also different from for example auto insurance - everyone has some chance to become a public burden. With car insurance it's easy - don't drive, and you wouldn't have liability claims. With health insurance it is different - you might live healthy life, and then suddenly get brain cancer and require VERY expensive treatment.


Health insurance is not health care. If someone is already barely making it financially or not making it the difference in a $10,000 bill, a $100,000 bill and a million dollar medical bill is neglible to them. If someone is doing a little better, they should take steps to protect their assets.

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This doesn't make sense. If one can't afford health care, how is providing them insurance they can't pay for going to lower healthcare costs?

Easy. Treating sore throat, bad cold or a fever in a doctor office is cheaper than doing it in emergency room. Currently those who cannot afford healthcare, have only one treatment option - which is also the most expensive one. By providing them insurance they would be able to go to a doctor office, and we the taxpayers wouldn't be paying for them in ERs.

Preventive care is also important. This is not something uninsured could get in ER, and for a lot of diseases early detection decreases overall treatment costs dramatically, and often means less people to get infected from them.


There are free clinics and other options but the truth of that matter is those that don't have to pay, generally don't care. Unless banned from doing so, the ER will still be the primary source of care for those not paying.

While I agree that the costs of preventive care decreases overall treatment cost on a per incident basis, what that doesn't factor in is the cost of that care on a wide scale when everyone starts coming in for preventive care for everything because it's "free."
Ex. If preventive care is now 1/5 of cost, but now instead of late stage treating 5 people for one thing, you're doing prevent care for 40, it's actually costing more.

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Less insured people means less paying in which means less to cover existing claims without dropping more people and/or raising rates.

Existing claims are supposed to be covered by premium already collected. An insurance plan which relies on future payments to cover existing claims is by definition not self sustaining, and is pretty close to Ponzi scheme.


Actually most insurance companies have insurance as well for larger claims and smaller ones are probably payed with loans, not the principle.

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Not health plans, health industry stock. If this passes it will skyrocket as the government will be paying for more services for more people. Health insurance companies will "pawn off" their preexisting condition people and those with large claims to the gov't while raising the rates on the existing customers as the now have less people to collect from.

Did you read the bill? Insurance companies will not be allowed to deny coverage based on preexisting conditions, nor they will be allowed to dump insured. This was required exactly to prevent the situation you described.

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So people with insurance will be grandfathered in but new enrollment will become much tougher. Existing costs will skyrocket until people leave or they'll find another way around the system.

Regulations don't tend to stop things, they just slow them down until people find new loopholes or new ways to make up for the lost profits.

You'll see this in the new credit card requirements. Annual fees are going to come back with a gustso.

As there is only a market for very few private hospitals and health insurance companies, most companies will be forced to comply and cut their own costs as well. This is where the rationing of care and the denial of service really starts.


I do not understand this logic, as it assumes we'll suddenly get 40M more people to treat. We will not; those 40M uninsured are already receiving treatment, and that's why people have to wait 8 hours in ER to see a doctor. This will shift them from ERs to regular doctor offices, but I really do not see how it would significantly increase the amount of care.

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Health insurance doesn't solve this issue, it merely passes the burden of paying the bill to someone else.

No, it does - mainly because people now will go to ERs for _emergencies_, so the overall bill will be smaller.

OK for sake of argument, lets pretend that having a government plan is not going to eventually push private insurance mostly out of the system and not going to grow with mostly "castoffs" that will cost considerably more.

Let's use your 40 million number and say it stays constant. While the number of people stays constant, the number of claims will rise dramatically as getting treatment gets perceived to be easier.

Ex. If you have to wait 8+ hours in an ER you're most likely not going to go every time you have the sniffles.

However, if that wait is less and is less of a hassle, people are more likely to use it more as well as get things looked at they may have been dealing with for years.

This doesn't even cover the people who do riskier things because they now have insurance.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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So is that totally the fault of the banks and insurance companies that the gov't takes the "bad" off their hands essentially rewarding this sort of behavior?
If the government didn't do that, the market would eventually sort itself out. Credit and insurance might not be as cheap or easy to get, but it would be available.

That's what the bill is for. Health insurers will not be able to dump sick people on the government (i.e. rest of us to pay).

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Health insurance is not health care. If someone is already barely making it financially or not making it the difference in a $10,000 bill, a $100,000 bill and a million dollar medical bill is neglible to them. If someone is doing a little better, they should take steps to protect their assets.

True, it makes no difference for them, but it makes difference for the rest of us - who eventually will pay for his treatment. It makes huge difference for the hospital if they have to write off $10K bill or $1M bill, and multiple of those bills could easily lead to hospital closure.

Again, you think you misunderstood the main point of the healthcare bill. It is NOT to provide health coverage for uninsured. They already have it via ER. The point is to make sure hospitals and ERs are paid.

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There are free clinics and other options but the truth of that matter is those that don't have to pay, generally don't care. Unless banned from doing so, the ER will still be the primary source of care for those not paying.

Do you have any personal experience with those? Free clinics are good example of rationed care - cheap and good quality, but the availability is very low.

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While I agree that the costs of preventive care decreases overall treatment cost on a per incident basis, what that doesn't factor in is the cost of that care on a wide scale when everyone starts coming in for preventive care for everything because it's "free."
Ex. If preventive care is now 1/5 of cost, but now instead of late stage treating 5 people for one thing, you're doing prevent care for 40, it's actually costing more.

I'd say the scale is much larger, the costs of preventive care are likely to be 1/1000 and greater, depending on disease. Just consider the fact that someone who gets immunization or is early diagnosed with diphtheria will not be spreading it, resulting in fewer people to treat.

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Actually most insurance companies have insurance as well for larger claims and smaller ones are probably payed with loans, not the principle.

It doesn't matter. If the plan could only cover its obligations relying on voluntary future payments or member involvements, it is not self sustaining plan already.

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So people with insurance will be grandfathered in but new enrollment will become much tougher. Existing costs will skyrocket until people leave or they'll find another way around the system.

No, new enrollment will not be tougher. It could only be more expensive. Remember, insurance companies cannot discriminate over pre-existing conditions, so basically there is no room for them to deny coverage.

More expensive plan means people will join less expensive plan provided by another company. This is competition you want - in action.

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You'll see this in the new credit card requirements. Annual fees are going to come back with a gustso.

Where did you get it? I've received multiple credit card offers in last month, and none of them had annual fee. Maybe it's time to cross-check with reality?

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Let's use your 40 million number and say it stays constant. While the number of people stays constant, the number of claims will rise dramatically as getting treatment gets perceived to be easier.
Ex. If you have to wait 8+ hours in an ER you're most likely not going to go every time you have the sniffles.

Why then everyone else does not go to a doctor every time they have the sniffles? After all, those people have insurance.

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However, if that wait is less and is less of a hassle, people are more likely to use it more as well as get things looked at they may have been dealing with for years.

The wait will be more. As I said, it will move from ERs to doctors office. Hopefully there are more doctors than ERs.

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This doesn't even cover the people who do riskier things because they now have insurance.

But as you said above, if the person cannot afford it, it doesn't really matter to them if it's $10K or $1M bill, so why would it change now? You gonna be treated anyway, no matter whether you have it or not.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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So is that totally the fault of the banks and insurance companies that the gov't takes the "bad" off their hands essentially rewarding this sort of behavior?
If the government didn't do that, the market would eventually sort itself out. Credit and insurance might not be as cheap or easy to get, but it would be available.

That's what the bill is for. Health insurers will not be able to dump sick people on the government (i.e. rest of us to pay).

They won't dump them, they'll just screen new applicants more. Rather than not cover a preexisting condition for a new person, they won't cover them at all.

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Health insurance is not health care. If someone is already barely making it financially or not making it the difference in a $10,000 bill, a $100,000 bill and a million dollar medical bill is neglible to them. If someone is doing a little better, they should take steps to protect their assets.

True, it makes no difference for them, but it makes difference for the rest of us - who eventually will pay for his treatment. It makes huge difference for the hospital if they have to write off $10K bill or $1M bill, and multiple of those bills could easily lead to hospital closure.

Again, you think you misunderstood the main point of the healthcare bill. It is NOT to provide health coverage for uninsured. They already have it via ER. The point is to make sure hospitals and ERs are paid.


This is where the hospitals own insurance comes into play or they sell the debt to a collection agency. The same rules that should apply to individuals to protect their assets with insurance can apply to hospitals.

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There are free clinics and other options but the truth of that matter is those that don't have to pay, generally don't care. Unless banned from doing so, the ER will still be the primary source of care for those not paying.

Do you have any personal experience with those? Free clinics are good example of rationed care - cheap and good quality, but the availability is very low.


It's low because the ER is always available. Take the ER option away...

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While I agree that the costs of preventive care decreases overall treatment cost on a per incident basis, what that doesn't factor in is the cost of that care on a wide scale when everyone starts coming in for preventive care for everything because it's "free."
Ex. If preventive care is now 1/5 of cost, but now instead of late stage treating 5 people for one thing, you're doing prevent care for 40, it's actually costing more.

I'd say the scale is much larger, the costs of preventive care are likely to be 1/1000 and greater, depending on disease. Just consider the fact that someone who gets immunization or is early diagnosed with diphtheria will not be spreading it, resulting in fewer people to treat.


We'd really need to see numbers. In the case of immunization, cost per person for visit and for the drug vs. the number that actual came in needed treatment later.

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Actually most insurance companies have insurance as well for larger claims and smaller ones are probably payed with loans, not the principle.

It doesn't matter. If the plan could only cover its obligations relying on voluntary future payments or member involvements, it is not self sustaining plan already.

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By that definition, no insurance plan is self sustaining. Even banks aren't. Hell most businesses aren't. Look what happened last year when customers of WaMu and Wachovia made a silent run pulling out any money not FDIC insured. WaMu was bankrupted and Wachovia was bought in a fire sale.

So people with insurance will be grandfathered in but new enrollment will become much tougher. Existing costs will skyrocket until people leave or they'll find another way around the system.


No, new enrollment will not be tougher. It could only be more expensive. Remember, insurance companies cannot discriminate over pre-existing conditions, so basically there is no room for them to deny coverage.

More expensive plan means people will join less expensive plan provided by another company. This is competition you want - in action.


With the government mandates and restrictions there won't be cheaper plans as it's no longer worth the risk. Plus no company is going to just accept the loss of a profit stream. They'll find another way.

It's just more cat and mouse games. Rather than deal with the root of the issue, they "quick fix" by forbidding something. This way the government looks like they are addressing the issue. Companies find another way or the loopholes and the process begins anew.

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You'll see this in the new credit card requirements. Annual fees are going to come back with a gustso.

Where did you get it? I've received multiple credit card offers in last month, and none of them had annual fee. Maybe it's time to cross-check with reality?


Those regulations haven't gone into effect yet so of course they aren't charging fees. Right now they are trying to get as many people signed up as possible so when they do start charging annual fees (even if they have to "warn" everyone) they hope people will be lazy or just forget to cancel the card.

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Let's use your 40 million number and say it stays constant. While the number of people stays constant, the number of claims will rise dramatically as getting treatment gets perceived to be easier.
Ex. If you have to wait 8+ hours in an ER you're most likely not going to go every time you have the sniffles.

Why then everyone else does not go to a doctor every time they have the sniffles? After all, those people have insurance.

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However, if that wait is less and is less of a hassle, people are more likely to use it more as well as get things looked at they may have been dealing with for years.

The wait will be more. As I said, it will move from ERs to doctors office. Hopefully there are more doctors than ERs.

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This doesn't even cover the people who do riskier things because they now have insurance.

But as you said above, if the person cannot afford it, it doesn't really matter to them if it's $10K or $1M bill, so why would it change now? You gonna be treated anyway, no matter whether you have it or not.

Which is why this government option is not necessary. People are being treated already. Let's call it "triage" care and billed on their ability to pay. Granted they aren't getting preventive care, but with that large a number of people is it really cost effective?

Ex: a flu outbreak that takes a week or so to get past. Total cost per shot (visit and drug) $100. Using the same 40 million people number, it would cost $4 billion to immunize everyone. This does not include costs associated with adverse reaction to the immunization.

Since a large portion of them don't work and others may get sick days even factoring in lost wages combined with flu complications expenses you're going to be hard pressed to come anywhere near the preventive costs.

From a societal level, it just does not make economic sense to provide "free" insurance and preventive care to all. If it did, a private company would have already figure out a way to tap the market.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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They won't dump them, they'll just screen new applicants more. Rather than not cover a preexisting condition for a new person, they won't cover them at all.

Screening more would just make it much easier to prove that people would have been illegally denied the coverage because of pre-existing conditions. It will be much cheaper to just accept everyone who applied.

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This is where the hospitals own insurance comes into play or they sell the debt to a collection agency. The same rules that should apply to individuals to protect their assets with insurance can apply to hospitals.

Well, it doesn't help and we in California have seen several hospitals closed because larger than average number of people didn't pay.

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It's low because the ER is always available. Take the ER option away...

No, it's low because doctors only have limited time where they could see patients for free. Still a good place where uninsured could get immunizations for their kids.

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We'd really need to see numbers. In the case of immunization, cost per person for visit and for the drug vs. the number that actual came in needed treatment later.

There are more costs which are hidden. People who didn't get immunization and got infected will in turn infect more people. Longer treatment time means less availability for others, as the number of beds in hospital is limited. Longer treatment also means the person will be longer out of work, and therefore pay less taxes (and might lose the job as well).

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By that definition, no insurance plan is self sustaining.

That's what I was telling you.

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With the government mandates and restrictions there won't be cheaper plans as it's no longer worth the risk. Plus no company is going to just accept the loss of a profit stream. They'll find another way.

Of course, they might provide a more expensive plan with more options, or with better coverage (more than mandated 70/30 for example). Same way UPS and FedEx do. Same way private schools do.

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It's just more cat and mouse games. Rather than deal with the root of the issue, they "quick fix" by forbidding something. This way the government looks like they are addressing the issue. Companies find another way or the loopholes and the process begins anew.

So what do you consider root of the issue, and how would you realistically deal with it?

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Those regulations haven't gone into effect yet so of course they aren't charging fees.

Those regulations are already signed into a law, so the companies should already start "making for lost profits". Why would they wait for the effective date?

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Right now they are trying to get as many people signed up as possible so when they do start charging annual fees (even if they have to "warn" everyone) they hope people will be lazy or just forget to cancel the card.

You sound like you know some inner details. Do you work for a credit card issuer, or it is pure speculation from your side?

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Which is why this government option is not necessary. People are being treated already. Let's call it "triage" care and billed on their ability to pay. Granted they aren't getting preventive care, but with that large a number of people is it really cost effective?

What you suggest is already happening. The results: ERs are full and their resources are wasted on non-emergency things, which in turn costs all of us - in fact my own insurance company claimed that the number of uninsured people treated in ERs are the main reason the rates go up, as the hospitals have to charge everyone else to cover the costs. With raised rates the number of insured people drops down, and we have more uninsured which need to be compensated by another rate increase.

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Ex: a flu outbreak that takes a week or so to get past. Total cost per shot (visit and drug) $100. Using the same 40 million people number, it would cost $4 billion to immunize everyone. This does not include costs associated with adverse reaction to the immunization.
Since a large portion of them don't work and others may get sick days even factoring in lost wages combined with flu complications expenses you're going to be hard pressed to come anywhere near the preventive costs.

The estimated economic impact would be US$71.3 to $166.5 billion, excluding disruptions to commerce and society.

The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention

With $45 flu shot cost (they were still available in Bay Area last year; you don't need to see a doctor to get a shot) we're at 2B max (and some percentage will be covered by copays - it's still not completely free).

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From a societal level, it just does not make economic sense to provide "free" insurance and preventive care to all. If it did, a private company would have already figure out a way to tap the market.

From a societal level it definitely makes pretty much the same sense as providing free education to all. Of course there is no incentive for a private company to do so - private companies have different motives.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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So what do you consider root of the issue, and how would you realistically deal with it?

You already mentioned it:

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ERs are full and their resources are wasted on non-emergency things, which in turn costs all of us - in fact my own insurance company claimed that the number of uninsured people treated in ERs are the main reason the rates go up, as the hospitals have to charge everyone else to cover the costs. With raised rates the number of insured people drops down, and we have more uninsured which need to be compensated by another rate increase.

Offering an alternative while at the same time allowing ER's to close off except for actual emergency cases.

Tort and EMTLA reform will help as well.
Those that actually have to pay don't use the ER for non emergency care. Giving those that don't pay anyways insurance coverage does nothing to stop them from using the ER.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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Offering an alternative while at the same time allowing ER's to close off except for actual emergency cases.

That's what the bill is about - it is offering an alternative.
What kind of alternative you would offer?
Skipping non-emergency cases sounds good in theory, but the problem is who is going to do it? Obviously not a receptionist; in a lot of cases only the doctor could tell whether the case is emergent or not. And at this moment all the money are already spent, so no savings here.

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Tort and EMTLA reform will help as well.

Maybe. It depends on what kind of reform. Details please.

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Those that actually have to pay don't use the ER for non emergency care. Giving those that don't pay anyways insurance coverage does nothing to stop them from using the ER.

Well, it does. Now they just have no other option; if they have coverage, they will have another option, and at least some people will use it.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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Skipping non-emergency cases sounds good in theory, but the problem is who is going to do it?

Currently hospitals are not allowed to.

If allowed they could come up with some sort of plan such as "no walkups" or having one nurse or doctor assigned to assess all walkups. If non emergency direct them to visit whatever is their new source of care.

As for tort reform, a large portion on the high cost of care is the high cost of malpractice insurance. Reformation of tort laws to enable more judgements and less settlements would help as well.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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Currently hospitals are not allowed to.
If allowed they could come up with some sort of plan such as "no walkups" or having one nurse or doctor assigned to assess all walkups. If non emergency direct them to visit whatever is their new source of care.

The problem here is different - basically nobody but doctor could tell if the case is an emergency or not. To do so the doctor needs to see the patient, and in some cases see the lab exams results, like x-ray or MRI. At this moment the costs are already added up, so even if the case is non-emergent, treating is would add only a tiny fraction comparing to the costs already spent.

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As for tort reform, a large portion on the high cost of care is the high cost of malpractice insurance. Reformation of tort laws to enable more judgements and less settlements would help as well.

Tort reform is different subject, and does nothing to prevent "ER-no pay" scenarios. Also we have a kind of tort reform here in California, which caps medical malpractice suits, and it seems to do nothing to stop the soaring costs.

* Don't pray for me if you wanna help - just send me a check. *

[Bolas 5]

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Currently hospitals are not allowed to.
If allowed they could come up with some sort of plan such as "no walkups" or having one nurse or doctor assigned to assess all walkups. If non emergency direct them to visit whatever is their new source of care.

The problem here is different - basically nobody but doctor could tell if the case is an emergency or not. To do so the doctor needs to see the patient, and in some cases see the lab exams results, like x-ray or MRI. At this moment the costs are already added up, so even if the case is non-emergent, treating is would add only a tiny fraction comparing to the costs already spent.

This is where the doctor would need to ask themselves, "Based on initial assessment only, is this person in danger?"

If a patient presents with the sniffles, a sore back, low fever, etc. really all they need is an Aunt Agnes test, "You'll be fine until normal clinic doctor hours."
Which is still much better than a Coach test, "Walk it off..."

Until treatment is refused or there is some other disincentive, people will continue to use the ER.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[georgerussia 0]

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This is where the doctor would need to ask themselves, "Based on initial assessment only, is this person in danger?"

At the moment the doctor finishes up this evaluation, all the ER costs are already spent. If the results of initial evaluation are not obvious, then more tests are needed until the doctor can say whether the person should be admitted as inpatient immediately, or just be given some painkillers and let go. The only difference you suggest is that in the non-emergency case the doctor does not tell the patient their findings, and not write prescription - something not really important on cost savings.

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If a patient presents with the sniffles, a sore back, low fever, etc. really all they need is an Aunt Agnes test, "You'll be fine until normal clinic doctor hours."

You cannot screen out patients just by symptoms. Even a sore throat could mean acute tonsillitis or diphtheria - and sometime a lab test is required to see the difference. A cough with fever might mean flu or pneumonia, and might require x-ray to find it out. Vomiting and head pain might indicate meningitis. Even sending back someone with a flu telling them "you'll be fine" might not be a good idea as it's communicable disease.

In short, such approach is not really cost effective and too risky. If the patient gets home and dies, expect a malpractice suit - which, in such a case, would be pretty well-grounded.

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Until treatment is refused or there is some other disincentive, people will continue to use the ER.

As multiple revolutions have showed us, there is no disincentive for those who have nothing to lose anyway.

* Don't pray for me if you wanna help - just send me a check. *

[kbordson 8]

I just came back from spending over a week in a country that had "free" health care.

Anyone can present to the ER.

Anyone can get free medical evaluation.

Anyone can receive a prescription for the IV fluids, or the nitroglycerine, or the antibiotics.... and then have his/her family members leave that ER and go across to a different building and have that rx filled.

"Free" medical care.

Where do YOU put the mark for what government should or shouldn't cover?

The more that is covered, the more expensive it will be, the more it will need to be rationed. It all sounds good until put into practical application and it's you or your family member that is lying in the ER needing the rocephin.

[Bolas 5]

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I just came back from spending over a week in a country that had "free" health care.

Anyone can present to the ER.

Anyone can get free medical evaluation.

Anyone can receive a prescription for the IV fluids, or the nitroglycerine, or the antibiotics.... and then have his/her family members leave that ER and go across to a different building and have that rx filled.

"Free" medical care.

Where do YOU put the mark for what government should or shouldn't cover?

The more that is covered, the more expensive it will be, the more it will need to be rationed. It all sounds good until put into practical application and it's you or your family member that is lying in the ER needing the rocephin.

So a "free" system that can only survive via the kindness of doctors from other countries volunteering?

Sounds perfect.

Stupidity if left untreated is self-correcting
If ya can't be good, look good, if that fails, make 'em laugh.

[mnealtx 0]

She just does it for the free jump into the location....

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[wmw999 2,122]

Remote Area Medical was founded to put people into remote foreign places (those of you who have been around awhile might remember that they used to talk about parachuting groups in sometimes - there were articles in Parachutist etc). The majority of their work is in the USA now.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)