Non-Americans with universal healthcare. Do you prefer your system or privatized like the U.S. Why?

[Augustus]

Most physicians are in private medical groups, and they are for profit, and that is a good thing.

A physician is rarely an employee. He has a vested interest in providing quality service in a timely matter. If he does not, market forces apply and the customer will find another health care provider.

The problem with 'free market' healthcare is that most patients lack the knowledge to judge the quality of their care or what is best for them.

I use a large multinational healthcare provider where I live (not the West) that would be considered one of the best in the country.

I asked my doctor why I appeared to be being given more medicine and more tests than were necessary and she told me it was standard practice.

This was for 2 reasons, one is the obvious profit motive and as insurance pays most people don't care about this. As well as unnecessary treatments, they also choose the more expensive options for medicines, etc. when ones that cost a fraction of the price would be equally effective. Personally, I prefer my treatment not to be viewed through a revenue enhancement lens though.

The second was that people expect treatment. The less the doctor does, the more people complain as they want the doctor to "do something". Telling the patient to wait it out, or to change aspects of their lifestyle is usually judged to be worse than giving a load of tests and pills, and prescribing a 'magic fix' to problems that are best solved in a non-medical manner.

'Keeping the customer happy' is not necessarily acting in the customer's best interests, as people are judging the perception of good treatment, rather than good treatment itself.

This leads to a massive bias towards overtreatment, as is apparent in the US and many other places.

 

[Rival]

I know you see these stories in the media, but how common is it? Is it most places, or only a few?

Last few times I was in the UK I saw numerous dental surgeries actively advertising for patients, and given the same places wer doing so over many months it doesn't seem like they were in too high a demand.

I think there is some overdrama but certainly it is not easy. We have to travel pretty far to see ours, as far as most people are concerned. We can't find one in our local town, that's for sure - and there are at least three.

 

[shmogie]

The problem with 'free market' healthcare is that most patients lack the knowledge to judge the quality of their care or what is best for them.

I use a large multinational healthcare provider where I live (not the West) that would be considered one of the best in the country.

I asked my doctor why I appeared to be being given more medicine and more tests than were necessary and she told me it was standard practice.

This was for 2 reasons, one is the obvious profit motive and as insurance pays most people don't care about this. As well as unnecessary treatments, they also choose the more expensive options for medicines, etc. when ones that cost a fraction of the price would be equally effective. Personally, I prefer my treatment not to be viewed through a revenue enhancement lens though.

The second was that people expect treatment. The less the doctor does, the more people complain as they want the doctor to "do something". Telling the patient to wait it out, or to change aspects of their lifestyle is usually judged to be worse than giving a load of tests and pills, and prescribing a 'magic fix' to problems that are best solved in a non-medical manner.

'Keeping the customer happy' is not necessarily acting in the customer's best interests, as people are judging the perception of good treatment, rather than good treatment itself.

This leads to a massive bias towards overtreatment, as is apparent in the US and many other places.

Perhaps. However, most insurance companies require pre approval for significant tests or procedures.

The wise consumer, just like for any other product or service, should evaluate a physician based upon a number of factors, the most important being results.

I, and many people have changed doctors for a reasons that we feel are important, which in the US we have that freedom and right.

 

[Rival]

I, and many people have changed doctors for a reasons that we feel are important, which in the US we have that freedom and right.

We can change doctors too. Not a problem.

 

[9-10ths_Penguin]

Many in the U.S. argue against universal healthcare and how terrible it is, yet I never heard anyone from outside the states voice their disdain for it nor how they held an envious desire for U.S. style healthcare. Someone claimed that this was because you're too oppressed to know better. So what's the case?

From what I've seen, your hospitals are generally quite good. Most of the issues I have with the US is with the health insurance system.

One of my friends actually ended up moving from the US to Canada because of the US's crappy health insurance system.

She and her family had moved from Toronto to Florida when her Dad got a job as a professor there. Everything went fine until my friend was diagnosed with ulcerative colitis.

After a few surgeries and treatments there, their insurance company dropped them from coverage. I never got a clear idea of why - did they hit their lifetime max? Was it deemed a pre-existing condition? Not sure - but in any case, they were left with the choice of either staying there and going bankrupt - on a professor's salary - paying for their daughter's care out-of-pocket before running out of money or moving back to Canada and getting care there.

They decided to save their daughter's life by moving to Canada, which is how she and I ended up at the same school.

I'm sure that this sort of thing happens every day in the US with families that don't have Canadian citizenship to fall back on.

 

[9-10ths_Penguin]

I, and many people have changed doctors for a reasons that we feel are important, which in the US we have that freedom and right.

You only kinda sorta have that right. I've heard plenty of stories from Americans about how their insurance limits them to only specific doctors.

Here in Ontario, I'm covered at any doctor in the province.

 

[9-10ths_Penguin]

Canada is a mixed system. You can buy (or the employer pays for it, union negotiated) 'extras'. Often drugs, private rooms in hospitals, dental, optical, chiropractic, massage, etc. aren't covered under basics. But the plans usually have at least 3 options.

I think it's also worth pointing out that Canada's system doesn't put everything under state control.

@Father Heathen - here (Ontario), a typical doctor's office is a private business. They bill our public health insurer for their services. The government sets the rates for each service and does a bit of supply management (e.g. scholarships and grants for doctors who set up family practices in underserved areas, or who taje up a specialty that has a shortage of practitioners), but the doctor is typically a small business owner.

Hospitals are a bit different: here, they're typically run by non-profits that are arms-length from the government, but the government has a lot of power to impose decisions on them to make them run things the way the government wants.

 

[Augustus]

Perhaps. However, most insurance companies require pre approval for significant tests or procedures.

It's pretty hard to prove that many things are not medically necessary.

It is very easy to run up bills for very minor things: a few unnecessary blood tests, a more expensive medicines that have the same function as cheaper ones, prescribing 2 or 3 drugs when 0-1 would do, unnecessary trips to see consultants, etc.

When doctors' income depends on cost of treatment, would you expect all doctors to be perfectly altruistic about this?

The wise consumer, just like for any other product or service, should evaluate a physician based upon a number of factors, the most important being results.

How do you judge a GP on 'results'?

I, and many people have changed doctors for a reasons that we feel are important, which in the US we have that freedom and right.

You can change doctors in most universal systems too, you register with whoever you like. You can request preferences for hospital referrals etc. It isn't as fixed as you seem to think.

You can also go private if you want to, and then you can go anywhere you want. And this still costs less than the average American pays.

 

[shmogie]

You current system is horrendously expensive. You know that, right?

Really ? The British system is ¨ cheap ¨. This approach has created huge waiting lists for virtually all surgeries. Avoidance of required tests, virtually no freedom to select a physician.

You get what you pay for.

The last time I was in the hospital, I had a private room with 150 TV channels, leather recliners for visitors, and my surgeon was rated as one of the best in the nation.

My insurance paid all the bills and I had to pay nothing.

I could have chosen a lesser rated surgeon, a a less comfortable hospital if I wanted. The choice was mine, and I got a stay that was much better than if I had chosen a hosp[ital that put me in a room with one or more other patients, or on a ward.

The point is that I was not at the mercy of some government bureaucrat enforcing regulations that would have made my stay cut rate and and an even worse experience than it was.

I decided who would do the surgery, I decided when it would be done, and I decided where it would be done.

 

[shmogie]

Those who make a killing off the medical racket lobby to maintain the status quo and keep voters misinformed and ignorant.

What is the medical racket lobby ? Please elucidate

 

[shmogie]

You only kinda sorta have that right. I've heard plenty of stories from Americans about how their insurance limits them to only specific doctors.

Here in Ontario, I'm covered at any doctor in the province.

The limitations are not to specific physicians, but rather to large physician nets who have specifically committed to a particular insurance company. These nets include many docs of different specialties.

Further, there are provisions to go to a doc outside the net if required.

Most insurance companies do not use this approach.

 

[Vinayaka]

From what I've seen, your hospitals are generally quite good. Most of the issues I have with the US is with the health insurance system.

I've found there is excellent co-operation between US medicine, and Canadian insurance as well. Four times myself, spouse or a child was treated while in Hawaii. (Minor stuff) Each time all we had to do was give the hospital our extended care number, and that was it. They billed directly to here and let us be on vacation.

 

[shmogie]

It's pretty hard to prove that many things are not medically necessary.

It is very easy to run up bills for very minor things: a few unnecessary blood tests, a more expensive medicines that have the same function as cheaper ones, prescribing 2 or 3 drugs when 0-1 would do, unnecessary trips to see consultants, etc.

When doctors' income depends on cost of treatment, would you expect all doctors to be perfectly altruistic about this?



How do you judge a GP on 'results'?



You can change doctors in most universal systems too, you register with whoever you like. You can request preferences for hospital referrals etc. It isn't as fixed as you seem to think.

You can also go private if you want to, and then you can go anywhere you want. And this still costs less than the average American pays.

If it cannot be established that it isn´t necessary, then it should be done.

Physicians are paid based on services. They are not paid from prescriptions or tests, unless they are done in their offices, which it rarely is.

How do you get the point that going private costs less than the average American pays ?

I have insurance premiums, but I pay 0 for doctors, hospitals, tests or most medicines.

The average American has an employer based insurance program whereby they choose the extent of the coverage they want. Their employer assists with premiums on the plan they choose.

Results are easy to evaluate for a particular physician.

They are rated by private consumer agencies who do in depth patient satisfaction surveys, and these ratings are available for anyone to find.

Further, hospitals evaluate the docs who have attending privilege´s at their hospitals. These are based upon peer review and patient feedback. Those whose performance is not acceptable have their privilege´s revoked.

The tests are sometimes too many because American physicians sometimes practice defensive medicine, they aren´t making money off of them.

Our legal system allows anyone to sue a physician for malpractice.

Therefore, if a test or diagnostic procedure might be useful, and if not doing the test or procedure might lead to legal exposure, they err on the side of caution.

 

[shmogie]

... said the American speaking about other people's healthcare.

Does that chip on your shoulder ever get put down ?

No matter, your opinion means nothing.

 

[Terrywoodenpic]

When I was a boy all medical services were private in the UK ( My father was a GP.)
Since then I and my late wife have seen private consultants and had private operations (self Paid) as well as NHS ones.
I have also had a private hernia operation funded by the NHS in a private hospital when the Waiting lists became over extended. The surgeon was the same person who had seen me in the NHS hospital ????? I was out and back to work the next day.
Health services can be totally mix and match in the UK if that is what you want. there is no compulsion about it.
However Problem usually become worse and waiting time longer during periods of Conservative governments.
They have the illusion that buying services in will save money... It never works out that way. and adds admin and financial costs and delays.

At the moment we are going through a bad patch with a shortage of Doctors caused through changes to their contracts and pension rights, so that many are leaving, retiring early or going part time. One I know is doing all three. he is Retiring and drawing his fully paid up pension, selling his practice to a consortium. And will work just three half day sessions a week for them on salary, and then will fully retire when his partner is able to do so as well. What he will earn after tax will not be much different to what he is earning now. If he puts in another half day session as a locum it will be pretty much the same. and he is still in his 50's

The other benefit is that he will have none of the Admin and worry or cost and time spent of running his own business. And they will pay him back cash for the Value of his property and car park. As far as he is concerned that is all a WIN WIN.
Negotiations have completed, and contracts will be signed at the end of this month.

He is Just one of many senior doctors doing exactly the same thing. The changes that the Conservative government have made mean, that had he not done these things he would have lost a third of his income.

 

[Terrywoodenpic]

If it cannot be established that it isn´t necessary, then it should be done.

Physicians are paid based on services. They are not paid from prescriptions or tests, unless they are done in their offices, which it rarely is.

How do you get the point that going private costs less than the average American pays ?

I have insurance premiums, but I pay 0 for doctors, hospitals, tests or most medicines.

The average American has an employer based insurance program whereby they choose the extent of the coverage they want. Their employer assists with premiums on the plan they choose.

Results are easy to evaluate for a particular physician.

They are rated by private consumer agencies who do in depth patient satisfaction surveys, and these ratings are available for anyone to find.

Further, hospitals evaluate the docs who have attending privilege´s at their hospitals. These are based upon peer review and patient feedback. Those whose performance is not acceptable have their privilege´s revoked.

The tests are sometimes too many because American physicians sometimes practice defensive medicine, they aren´t making money off of them.

Our legal system allows anyone to sue a physician for malpractice.

Therefore, if a test or diagnostic procedure might be useful, and if not doing the test or procedure might lead to legal exposure, they err on the side of caution.

Any one can sue a doctor in the UK and they have to buy very expensive insurance to cover it out of their salaries.
An even bigger unknown cost is the time such cases take up out a doctors working schedule.
Serious cases almost inevitably cause the to be suspended if they work in a hospital.

 

[9-10ths_Penguin]

I've found there is excellent co-operation between US medicine, and Canadian insurance as well. Four times myself, spouse or a child was treated while in Hawaii. (Minor stuff) Each time all we had to do was give the hospital our extended care number, and that was it. They billed directly to here and let us be on vacation.

Where I am, the closest Level 1 trauma centre on the Canadian side is in London, so it's fairly common for the hospitals in Windsor to send serious trauma cases across the border to Detroit. It all still gets covered by OHIP.

 

[Vinayaka]

Where I am, the closest Level 1 trauma centre on the Canadian side is in London, so it's fairly common for the hospitals in Windsor to send serious trauma cases across the border to Detroit. It all still gets covered by OHIP.

We recently up and dropped our Extended Health Care Plan (teacher' sgroup plan) because I became a senior. and there are quite a few extras on the regular plan because of it. They wanted the same amount in premiums as before, with most of what we used it for being covered by the Senior's free plan. I have yet to use it much, and when we travel, we'll just purchase temporary travel insurance. Hopefully we won't even have to find out how it works.

But yeah, I appreciate the cross border co-operation.

 

[Nakosis]

Your government just spends more public money into healthcare than almost anyone else. Sweden just manages to cover the whole populace with that money. So does almost every other country on this list:

source: https://www.visualcapitalist.com/u-s-spends-public-money-healthcare-sweden-canada/

Right, so the problem IMO is the cost of health care which for some reason the government doesn't seem to want to do anything about.

 

[9-10ths_Penguin]

Right, so the problem IMO is the cost of health care which for some reason the government doesn't seem to want to do anything about.

Not just with the cost; also with who pays the cost and how it's paid.

For instance, attaching insurance coverage to employment seems absolutely bonkers to me.