Stipend as Welfare

Nice point Alexander.

WHAT HE SAID! ^^^^

Because it isn't illegal for them to make their own choice, i.e. if they do find someone who will pay for it or buy them some type of insurance, they can go ahead and do so. In this new bill, ONLY the government plan would be allowed.

(There is also free health care 'for the indigent' although it's fairly crappy - some say it will be just like that for everyone, if the govt. plan passes. Long lines, crappy quality care, etc. HMO are fairly like that and no one wants one given a choice.)

Was flu-ish and rested last night so didn't make any phone calls but I will. Until then I'm curious, how does Canada do it?*

*intentionally leaving that as a straight line

Are you telling me that the US Federal Government is seriously proposing to make it a criminal offense to a qualified doctor in good standing to practice private medicine?

If this is, in fact, the case -- and I have to say I find it rather surprising -- that's that's obviously barking mad but certainly isn't an inherent feature of public health provision in any other capitalist country of which I'm aware.

This is not an area of particular expertise of mine, but I'd say, broadly, we "do it" three ways:

1) Through somewhat higher taxes (although not outrageously so). That's the price that, historically, Canadians have been (and continue to be) willing to pay for a more developed social safety net generally.

2) Through different spending priorities. Our military budget, for example, is inifinitesimal compared to that of the US.

3) By regulating health costs, including, most significantly, how much can be charged for particular health services. This last HAS been a problem with the system, in that some Canadian-trained doctors (taught, ironically, at heavily subsidized Canadian universities for a fraction of what they would have paid for their degrees at a comparable US institution) will move to the States where more of a free market system reigns, and they can earn more. Canada's solution to that has been to import doctors from other nations, which itself has become an issue because it is said that we are depriving Third World Nations of desperately needed medical personnel.

Well ... actually, in Canada, a doctor is not allowed to "opt out" of the system, if that is what you mean: she or he has to charge the government-regulated rates for health services, and cannot bill the patient directly (except for certain types of procedure that are not covered by medicare, mostly along the lines of cosmetic or elective surgery). Some provinces in Canada used to permit "extra billing" -- a charge directly to the patient over and above that paid by the system -- but that practice was stamped out some years ago.

I suspect you will find that most European nations have similar systems. In the West, it is the US that is the aberration in this regard, I think.

Anyone with sufficiently low income has their premiums subsidized in Canada. Hospital care is triaged based on emergance, i.e. immediate life threatening situations first, non-life threatening situations usually in queue order.

Wait time statistics get skewed somewhat too in that rural communities usually do not have the same facilities that urban communities do. There is a lot of hand wringing over that but not sure that much can be done about it (the population distribution here and implications on infrastructure costs are one of the biggest challenges Canada faces generally, not just in health care).

There are some noteworthy exceptions. Sports teams usually have their own medical teams and facilities. Also workman's compensation board patients (those injured on the job) are in a different queue that usually has precidence over non-emergant cases.

Private insurance is what I was told would be outlawed. I will need to clarify that with more details and plan to do so soon. The people I need to ask are busybusybusy and I've been a bit flu-ish lately to phone anyway.

I will ask this question as well.

Scylla - that may be partly why this one will be set up to fail. Americans don't want higher taxes, the economy is struggling on top of all of that, and our identity seems based around free market competition.

But, people also have been clamoring for free health care for a while now, and we've had a lot of citizens from other countries, who have brought a different outlook in as well. So in the near future all of the above may change. I think my country is changing so rapidly sometimes I think I won't recognise it soon. But that's in many, many ways.

I'll ask Scylla - in Canada, can a doctor charge more than allowed, or set up a private practise?

You beat me to the answer. If someone is completely indigent, medical care *is* paid by the state via a combination of Medicare and each state's individual program - many are called Medicaid but in some states it has a different name.

Some people who do have money kind of "work" the system. Let's say there is an elderly person who has a health situation that likely will eventually need to be admitted to a nursing home. Some people who have funds will transfer their assets to family members so that "on paper" it looks like they have nothing and then the state funds kick in. (I don't advocate that btw...just saying it exists but now to keep that from happening as much as it once did there is a certain number of "look back years" the state considers.)

I already recounted the situation of the nursing home my grandfather was in, paying cash for what insurance didn't cover because he was fortunate to have worked and saved and had the money. HOWEVER, in the same facility, receiving the same level of care were people who had nothing. The care, once again was paid by a combination of Medicare/Medicaid.

There is always a way for someone to receive care if they need it. As much as someone may try to spin the story "right wing", the "left wing" makes it sound like there are just millions of destitute Americans who can not get care and I have worked in health professions and have personal experience to know that is definitively NOT true.

I'll be transparent here...I live with an illness that eventually progressed to the point that I cannot work now. Having been a professional career woman, that killed my "pride." However, of necessity I applied for food stamps and Medicaid, both granted almost immediately as I had NO income.

Now I am on disability and have Medicare and a prescription drug plan that Medicaid pays for.

You know what...I had the SAME medical care now as I had when I was on Medicaid and it cost me NOTHING. Now that I have the grand total of $700/mo in SS income, I have co-pays, etc.

The other issue is the having to wait. I have not heard anyone in any country with socialized medicine not admit there is not a longer wait for services.

So, again, I'm glad those of you who live in countries with socialized medicine are happy with it. And if one is relatively young and healthy, it may not seem like a big deal. Wait until you are older and/or have a life-threatening condition.

I detest heated debates...but I'm not budging on this one and I am proud of my fellow Americans that it seems like many are finally "waking up on this one" and from what I hear on the news and talk shows, Congress is getting quite an earful from their constituents on this one.

I am now bowing out of this discussion as I think I have clearly stated my opinions.

Oh I don't even see this as a heated debate, personally, Czari. Everyone's voicing their opinions, concerns, experiences, and what they have read or heard. I think everyone's been respectful of differing views.

You've added a lot to the discussion. I see no reason to feel you've said too much or should leave, but of course, it's up to you.

I've heard about people who could afford to, coming to the U.S. for major operations or treatment also. Because the socialised medicine meant a lot of the better doctors or surgeons came here. And also, because then they could get it right away instead of waiting for the govt. to decide who lives or dies.

Why not simply add more govt. run care facilities, surgeries, etc. I don't see how we can afford to give care to everyone for free, when so many hospitals, ERs, and free family health clinics have had their funds CUT by the govt. to the point they had to close. A lot of very fine doctors/surgeons volunteered at the free family health clinics in their 'spare time.'

About nursing homes - well, I think the way it's done to begin with stinks. Someone saves all their life, and then has to pay $1000 or more a day to live in squalor in a nursing home? Why is it sooo expensive? People running some of those places are filthy rich from gouging desperate and ill seniors to live there. I say *no wonder* if some give their money to their kids first, so the state pays for the care. The whole system with nursing homes is criminally negligent, greedy, and often abusive to boot.

But then I had a relative who could only afford to stay in a cheaper 'old folks home', wasn't on the waiting list in time for the 'good place' and was basically beaten and thrown down a flight of stairs - the staff were dealing drugs from the place and were busted for it more than once, but it would just reopen. I found out most of it later...and was too far away and not in a position in the family to be able to help. That treatment broke their heart they died shortly after. I have a photo of them with a black eye to remember them by. THAT is how well the govt. are policing things already.

47 million uninsured.... whatever

- 38 percent of this 47 million -- almost 18 million -- make more than $50,000 a year, 10 million of them make more than $75,000.

I really do not feel like paging through a book and finding the break down of the 47-50 million uninsured americans.

18 million choosing to not insure themselves will be receiving our welfare health care on the backs of those that work and pay into the system because they do not want to - they choose to spend their money on porn, gambling, drugs, credit card debt (which they should not have run up in the first place!!!!) etc..

Let them eat cake on the tax dollars of someone else.

This actually does come pretty close to the truth. Though, my understanding is that folks will not really be denied service "because you are too old", but that will basically be what it amounts to.

Actually, Alexander clearly knows the technical aspects of the system far better than I, although I can confirm from my own knowledge what he has said here. But with regard to private practice, or extra billing, my post on that obviously arrived while you were writing yours.

I DO think that there is an enormous cultural difference between the USA and Canada that is frequently overlooked in the tendency to think of all North Americans as being pretty much alike. Canadians themselves make much of this, too much perhaps, but it is often pointed out that while Americans are promised "Life, liberty, and the pursuit of happiness," Canadians historically want "Peace, order, and good government." You ARE more "free" in some ways in the US, I think, but in Canada we have always tended to be further along on the political spectrum towards, not merely the left, but also the notion of collective rights and responsibilities, somewhat at the expense of individual or personal ones.

This all has historical roots. Our governmental structures, but also to a great degree our social priorities, owe far more to Great Britain than they do to our closest neighbour (although that may change, who knows?). The US, on the other hand, was born at the height of the Englightenment and the dawn of Romanticism: the values you continue to cherish there are the legacy of that, among other things.

Excellent post.

Yes and it's changing extremely rapidly toward becoming much more like cold war era USSR than anything like where it all began. Our Founding Fathers must be doing whirligigs in their tombs.

Actually, even with adequate health insurance, everything now has to go thru pre-authorization and the insurance companies can deny things for the craziest reasons or simply stall the authorization until it is too late.

Happily (for me), this is an American debate, and not a Canadian one. Clearly some Americans feel differently, but I would no more try to dictate how you, as an American, should feel on this issue, than I would want you telling me, as a Canadian, how we should run our affairs.

I can tell you that Canadians are generally pretty happy with our system, and that it actually works pretty well. I think it is a more just, compassionate, and humane system, but I will agree that it is a less "free" one. Depends on where your priorities lie, I guess.

Now that part sounds just like the US.

A nice alternative to the mega-corp insurance companies are smaller, privately run paid-into health care. The place of employment sets the terms and chooses the plans and employees tend to have a say in it.

Of course that doesn't do much for those who are unemployed, unless they are on someone else's plan.

Warning: Long , humorless rant.






I have a good private insurance plan...that I pay for myself. I am fortunate to be able to do this, I know. I will be the first to say the current system is ineffective and needs replacing. However, it is a long standing tradition in this country that whenever the Government deems something ineffective and in need of replacing they invariable replace with something as inefficient and ineffective, or worse. This plan as I see it is no exception.

We are already overtaxed and underserved, our public schools are a mess, many cities and states are near bankruptcy, social safety net services are riddled with waste and fraud, and we are mortgageing our grandchildren to bail out failed banks and automakers who were driven to failure by their own management and in many ways by the very people in Washington who are now coming to their rescue, to the tune of TRILLIONS of dollars. *Cash for clunkers, anyone?*

We have a President now, who 4 years ago was an unknown entity, who had no experience at adminstering any sort of large entity saying he can fix it. He points the finger at his predecessor's failed policies, policies that he and his compatriots on The Hill had a lot to do with enacting and enabling.

This issue has been almost a singular obsession with these people, and it is important. But if it is so important, why are they trying to cram it down everyone's throats, without debate, or discussion. ? What is the urgency? Shouldn't it be carefully studied and explained, clarified and optimized? Shouldn't it be set up for maximum success at minimum expense?

The answer , at least to me is not ever expanding, lumbering government. It creates nothing but inefficency, incompetence, corruption and complacency. It becomes nothing but a vehicle for self sustainment. Make the people dependant on you and you have a jobe for life.

People should have access to health care in times off serious illness. And if they can't afford it they should receive it free. But that doesn't mean a case of the sniffles for a flu shot require an ER visit at $900 a pop. And a doctor should be billing an insurance company for major surgery when all a person is getting is a checkup. A sanely regulated and competitive system is the answer, in my opinion. Encourage doctors to open clinics, just like any other consumer business. reform the malpractice insurance system, put an end to frivolous lawsuits, encourage private charities and individuals to engage in supporting healthcare services in their areas.

Many fine medical professionals arrive inthis country each year, unable to work due to certification issues. Make it easier to prove their competence and certify them, and let them work in Public Hospitals and clinics in exchange.

Right now, all that is being proposed, at least to me is replacing one corrupt and inefficient system with one that will be even more so. But it will just have a stamp of legitimacy on it.
No, I don't trust our government, or the people in it one bit. And I don't want them involved in anyway in deciding my health or that of my family.

End of Rant.

This site does a semi decent job of explaining where this "private insurance will be illegal" thing came from and what it all really means:

http://www.politifact.com/truth-o-meter/statements/2009/jul/22/ibdeditorialscom/private-health-insurance-page-16-house-bill/

The legal person I talked to said that the above article is in fact correct. Have your friend check that stuff out.

This very well said. I agree with it wholeheartedly.

LittleMe: I will try and send the link once I've spoken with them first, to find out more but I am pretty sure they have researched the issue already and long before the current proposal.

The Clintons were the first to try and get such a bill passed. What a coincidence look who is the Sec. of State.

Sort of a Healthcare Credit Union. I've heard that mentioned before. It is a good idea.

Skimming through the new direction of this thread [US healthcare] makes me glad I don't live in the USA. Did you folks know that a substantial number of your people come to Yoorp for their treatment? And not to England... but to 'cheese-eating surrender-monkey' France where the healthcare system is about the best in Yoorp. Strange that.

Thanks Brenda. It is already available, just not as widely used as it might be.

Such plans often pay for things state-run or corporate health care will not - so in effect are subsidising those plans. If outlawed, those recipients would be out of luck - perhaps.

Alazarin - Haven't ever heard of an instance like that. We have some pretty good hospitals here. I'm not claiming it never happens, of course.

But are doctors not allowed to practice privately in Canada?

Certainly in the UK, doctors can work wholly for the NHS or wholly on their own account or have a mixed practice. A surgeon friend of mine performs non-urgent operations on NHS patients on certain days and private patients (i.e. those funded by insurance companies) on others, the difference being you get your choose the date of your non-urgent surgery (and you probably get it sooner) if you see him privately. Many European countries have a similar set-up, as far as I know.