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Yet Another Health (s)care thread

disappoint

Lifer
Dec 7, 2009
10,137
380
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So I saw this on the news the other day where they were comparing Canadian health care to the U.S.

A few figures they threw about were that in Canada:

The billing dept of a hospital had about 50 people in it, whereas the same sized hospital in the U.S. would have about 800-900 people in the billing dept.

Heart surgery would cost $22,000 in Canada but $127,000 in the U.S.

Then they went on to talk about how the CEOs of insurance companies in the U.S. make hundreds of millions a year.

Essentially they were making the argument that the biggest problem in the U.S. healthcare system is waste.

So do you agree or disagree?
 

Matthiasa

Diamond Member
May 4, 2009
5,755
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Waste is the biggest problem in nearly everything, why would health care be any different?
 

TruePaige

Diamond Member
Oct 22, 2006
9,878
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I just have to ask...

What hospital has 800-900 people in the billing department? Son of a bitch.
 

Matthiasa

Diamond Member
May 4, 2009
5,755
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Could be a a hospital system? So like a few dozen/hundred hospitals under some company.
 

Ronstang

Lifer
Jul 8, 2000
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If waste is the problem, and I am not saying it is or isn't, then how do you expect the US government to do anything but harm? They are the biggest wasters on the planet.
 

disappoint

Lifer
Dec 7, 2009
10,137
380
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Don't know which hospital had 800-900 people in the billing dept. They didn't specify, all they said was same size as the Canadian one. Maybe it was just before downsizing the dept. so that figure alone might not sway me to agree.

If waste is the problem, and I am not saying it is or isn't, then how do you expect the US government to do anything but harm? They are the biggest wasters on the planet.
It is certainly a problem in a lot more than just the healthcare industry unfortunately. I think we as a nation may be forced to address it if it gets to the point where we hit "rock bottom" I would hope before that point but human behavior shows otherwise in some cases.
 

Throckmorton

Lifer
Aug 23, 2007
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If waste is the problem, and I am not saying it is or isn't, then how do you expect the US government to do anything but harm? They are the biggest wasters on the planet.
How do you figure that the US government is the biggest waster on the planet? We have the lowest taxes in the developed world, yet we are the only superpower.
 

woolfe9999

Diamond Member
Mar 28, 2005
7,164
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This is the real selling point for single payer. With only one payer, there is no itemized billing. Our medical system generates billions of pages of bills every year. Each hospital employs 50-100 people to generate this billing, and then some insurer (whether government or private), has an equivalent number of people going through these bills item by item. Cumulatively this is about 20% of our healthcare costs. With only one payer, the hospital submits a monthly cost accounting to the payer and gets reimbursed for its costs. It is a ton less bureaucracy. As soon as you introduce a second payer, hospitals have to generate bills in order to apportion charges as between the different payers. The savings with single payer aren't really about it being a government payer; it's the fact that there's only one.

Kaiser Permenente is an example of a single payer system in the U.S. which is private but also non-profit. It's both a provider and an insurance company in one organization. Hence, it need not generate any bills (except to bill patients for small co-pays.) It is able to provide about middling quality care at very low rates because of this.

- wolf
 
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JEDIYoda

Lifer
Jul 13, 2005
33,662
3,138
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The billing dept of a hospital had about 50 people in it, whereas the same sized hospital in the U.S. would have about 800-900 people in the billing dept.
That is a very ignorant statement and totally wrong!!
 

Danube

Banned
Dec 10, 2009
613
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The US vs Canada prob is not what it always seems. Canada has cheaper drug costs because the gov said if US doesn't sell drugs cheaper to Canada they will only honor drug patents a few years (and then make their own). What looks like beneficence to some on Canada's part concerning costs is really the bird being flipped to US.
 
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Ozoned

Diamond Member
Mar 22, 2004
5,578
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So I saw this on the news the other day where they were comparing Canadian health care to the U.S.

A few figures they threw about were that in Canada:

The billing dept of a hospital had about 50 people in it, whereas the same sized hospital in the U.S. would have about 800-900 people in the billing dept.

Heart surgery would cost $22,000 in Canada but $127,000 in the U.S.

Then they went on to talk about how the CEOs of insurance companies in the U.S. make hundreds of millions a year.

Essentially they were making the argument that the biggest problem in the U.S. healthcare system is waste.

So do you agree or disagree?
I absolutely agree. Our government allows 60 billion a year to be stolen through fraud in Medicare and Medicaid. That is nearly 10% of the budget for those items.
Why don't you add up the collective CEO pay of all health insurance companies and see how it compares?
 

nonlnear

Platinum Member
Jan 31, 2008
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Except you have to wait 1-5 years in Canada for that $22000 surgery, whereas in the US that $127,000 will get you in the door ASAP. Is a wait time of (often) years worth $100,000? Hell yes. Why do you think Newfoundland's premier came down here for his heart surgery?

Comparing prices straight across is not an apples to apples comparison. The price differences may often seem astronomical, but when you consider that that price difference may buy years of improved QOL and may also be the difference between dying on a waiting list it suddenly isn't quite that bad.

Good luck getting an MRI out of the single payer system in Canada. You'll be waiting quite a while if you don't want to pay out of pocket.

There are some serious issues with the American system that could bring prices down dramatically if addressed, but they have very little to do with the differences between single and multi payer systems. A big problem with single payer is that you lose the valuable information created by a market. That's why you often end up with dramatic under supply of certain services. The prices also become inherently politicized and you end up with massive overhead that is off the books in the form of lobbyists arguing over reimbursement rates. The entire legislature and executive becomes one big billing department if you want to make a fair comparison...
 
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Arglebargle

Senior member
Dec 2, 2006
892
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I remember very well my veterinarian telling me that he could sell me a prescription drug I was taking for a quarter of the price, and still make a profit. And it would be of higher quality, because dogs couldn't tolerate the impurities that well.

That was the same time my preapproved medical bills were also being blanket denied by the same insurance group that had pre-approved them. Always wondered where this fantasy health insurance world was, because I sure never saw it.
 

desy

Diamond Member
Jan 13, 2000
5,376
146
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Oh the hyperbole
A drugs are cheaper in Canada cause they choose generics and bulk buy
the downside is the latest drugs often get left off the table as an option
B The overhead is way less when you don't have myriads of accountants
C if you need heart surgury and its life threating YOU WILL GET IT
however if its a non lifethreatening hip replacement YOU WILL WAIT

As a Canadian I've never pointed to our model as the one to follow and oft wished that a more hybrid system will develope, however just as you fear socialism Canadians fear the bad old days of medical bankruptcies

Danny Williams went to the US cause he didn't bother to investigate options within Canada and cause he is a MULTIMILLIONAIRE and they don't think the same as avg people do

Funny my wife has had two MRI's in the last 6 months and if she wanted could go pay $500 for one and have it done tomorrow in Canada
 
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nonlnear

Platinum Member
Jan 31, 2008
2,497
0
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Oh the hyperbole
A drugs are cheaper in Canada cause they choose generics and bulk buy
the downside is the latest drugs often get left off the table as an option
B The overhead is way less when you don't have myriads of accountants
C if you need heart surgury and its life threating YOU WILL GET IT
however if its a non lifethreatening hip replacement YOU WILL WAIT

As a Canadian I've never pointed to our model as the one to follow and oft wished that a more hybrid system will develope, however just as you fear socialism Canadians fear the bad old days of medical bankruptcies

Danny Williams went to the US cause he didn't bother to investigate options within Canada and cause he is a MULTIMILLIONAIRE and they don't think the same as avg people do
There are a LOT of conditions that you will wait for in Canada. Just because something is not life threatening doesn't mean it's not urgent - but it does mean it's not urgent in Canada. I have a mother and sister who are receiving crappy ass care up there. (I'm glad they are my only family members with chronic conditions.) I can't bear to tell them how awesome our health care is here in the US because they would cry.

It is far from perfect, and a lot needs to be done to improve things. However people who prattle on about how amazing all single payer systems are are usually spouting talking points that have been cherry picked from a reality that is much more muddled.
 

desy

Diamond Member
Jan 13, 2000
5,376
146
106
Right, thats where I said I'd prefer a more hybrid system so if its important to you, go ahead and pay for it to get it done.
Most people who don't get good health care here isn't because its not available its because they suffer from 'doctor knows best' and don't bother with second opinions or take some ownership to get directed to a specialist

I pointed out several failings however IMO single payer advantages outweight the cons
cost being the most significant
Point was the rhetoric against is so skewed how can you make a legitimate opinion when all many here do is expouse the anecdotal one ofs as AHA moments when every system has cracks
 
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nonlnear

Platinum Member
Jan 31, 2008
2,497
0
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Right, thats where I said I'd prefer a more hybrid system so if its important to you, go ahead and pay for it to get it done.
Most people who don't get good health care here isn't because its not available its because they suffer from 'doctor knows best' and don't bother with second opinions or take some ownership to get directed to a specialist

I pointed out several failings however IMO single payer advantages outweight the cons
cost being the most significant
For my folks up in BC now the problem is more that the specialists are simply not available. And they're not in the middle of nowhere either.
 

desy

Diamond Member
Jan 13, 2000
5,376
146
106
Right we needed specialists so we went to Alberta all covered and paid for by Sask health.
Ask for it
We are also getting into a program called 'second opinion' where we will probably end up going to the US, Mayo or John's we haven't decided yet, paid for by Sask health

My wife has had a decade of health issues all handled competantly and timely, however some things we'd like to see more of is laporoscopic types of treatments, ergo why we are rolling to the states. Also, what she has is uncommon and has multiple legitimate treatment options and why we are pursuing all avenues
 
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woolfe9999

Diamond Member
Mar 28, 2005
7,164
0
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Except you have to wait 1-5 years in Canada for that $22000 surgery, whereas in the US that $127,000 will get you in the door ASAP. Is a wait time of (often) years worth $100,000? Hell yes. Why do you think Newfoundland's premier came down here for his heart surgery?

Comparing prices straight across is not an apples to apples comparison. The price differences may often seem astronomical, but when you consider that that price difference may buy years of improved QOL and may also be the difference between dying on a waiting list it suddenly isn't quite that bad.

Good luck getting an MRI out of the single payer system in Canada. You'll be waiting quite a while if you don't want to pay out of pocket.

There are some serious issues with the American system that could bring prices down dramatically if addressed, but they have very little to do with the differences between single and multi payer systems. A big problem with single payer is that you lose the valuable information created by a market. That's why you often end up with dramatic under supply of certain services. The prices also become inherently politicized and you end up with massive overhead that is off the books in the form of lobbyists arguing over reimbursement rates. The entire legislature and executive becomes one big billing department if you want to make a fair comparison...

Which surgeries are you claiming you must wait 1-5 years for in Canada? Can you please source that comment?

- wolf
 

nonlnear

Platinum Member
Jan 31, 2008
2,497
0
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Which surgeries are you claiming you must wait 1-5 years for in Canada? Can you please source that comment?

- wolf
First, sorry for the 5. That really was out of my ass. I was writing carelessly.

My mom got bumped for over two years to get a thyroid surgery a while ago. There was no rhyme or reason to it either. Her OR booking kept getting bumped for higher priority patients, and then after a bump or two they would have to get new tests because the original ones were too old. There was no evidence that when she finally got in that it was for any coherent reason. She just happened to get lucky. I saw no reason to believe the process would ever have a sensibly determined termination date. Granted the 5 was an arbitrary number but the upper limit on such a figure is always going to be largely irrelevant (what with the number vs. wait time relationship being roughly exponential decay by then).

I actually hope I am very wrong about the 5 (and on the high side, that is!). There are few instances of incorrectness on my part that would make me happier. If they have managed to implement a system that effectively caps wait times that would be fantastic.
 
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woolfe9999

Diamond Member
Mar 28, 2005
7,164
0
0
First, sorry for the 5. That really was out of my ass. I was writing carelessly.

My mom got bumped for over two years to get a thyroid surgery a while ago. There was no rhyme or reason to it either. Her OR booking kept getting bumped for higher priority patients, and then after a bump or two they would have to get new tests because the original ones were too old. There was no evidence that when she finally got in that it was for any coherent reason. She just happened to get lucky. I saw no reason to believe the process would ever have a sensibly determined termination date. Granted the 5 was an arbitrary number but the upper limit on such a figure is always going to be largely irrelevant (what with the number vs. wait time relationship being roughly exponential decay by then).

I actually hope I am very wrong about the 5 (and on the high side, that is!). There are few instances of incorrectness on my part that would make me happier. If they have managed to implement a system that effectively caps wait times that would be fantastic.
Fair enough. I can't speak to individual experiences other than what some Canadian friends have told me. I only know what I've read. The example given above in thread was for heart surgery. My understanding is that for any kind of surgery to correct a life-threatening condition, there is no greater wait time in that system. Bypass surgery, cancer surgery, apendectomies, etc. you're fine. It's generally "elective" surgeries, such as joint replacements, where there are wait times. My understanding is that wait times are usually between 3 and 6 months. But that is of course a generalization and I'm sure individual experiences vary.

Incidentally, the wait times which do actually exist in these systems are not necessary structual components of a single payer system. They are, rather, a consequences of tradeoffs made in those speicifc systems to save more on cost. Significant (but lesser) cost savings can be achieved without these tradeoffs.

- wolf
 
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nonlnear

Platinum Member
Jan 31, 2008
2,497
0
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My understanding is that for any kind of surgery to correct a life-threatening condition, there is no greater wait time in that system. Bypass surgery, cancer surgery, apendectomies, etc. you're fine.
This much is pretty well true.
It's generally "elective" surgeries, such as joint replacements, where there are wait times. My understanding is that wait times are usually between 3 and 6 months. But that is of course a generalization and I'm sure individual experiences vary.
I do think my mom's situation was one of the worse instances. Hers might not even be representative. It was a real mess, as it wasn't just a matter of waiting for the OR booking. The diagnosis kept having to be revised because of the wait.

Her condition was not life threatening at all, but it was completely debilitating. She was sleeping about 16 hours a day, had non stop hot and cold flashes, sweats, etc., not to mention the many other minor discomforts that come with hyperthyroidism. The one thing that was certain was that it was not life threatening.
Incidentally, the wait times which do actually exist in these systems are not necessary structual components of a single payer system. They are, rather, a consequences of tradeoffs made in those speicifc systems to save more on cost. Significant (but lesser) cost savings can be achieved without these tradeoffs.
I'm not one to say that all single payer systems must by definition be terrible. That would be ludicrous. (Even more ludicrous than that would be to say that a health care system with no government involvement in any way would be wonderful!) However what you are alluding to here is related to the fact that I pointed out earlier: in a single payer system the allocation of resources is transformed into a purely political matter. Some people see that as a benefit and some people see that as a disadvantage. Few people's minds will ever be changed on the question of whether that is a good or a bad thing...

I will freely admit that my bias in this matter has only a little bit to do with the details of health care, and much more to do with my personal understanding of how my conscience relates to society, and the nature of gangs - er - governments.
 

heyheybooboo

Diamond Member
Jun 29, 2007
6,278
0
0
I absolutely agree. Our government allows 60 billion a year to be stolen through fraud in Medicare and Medicaid. That is nearly 10% of the budget for those items.
Why don't you add up the collective CEO pay of all health insurance companies and see how it compares?
I tend to look at fraud the way I look at immigration issues.

Start slapping $25k fines for each 'incident' along with 10-year jail terms for offenders, and I suspect a good bit of the fraud will go away.

As far as the insurance companies, it's the 'bad' actors (and actions) that drag the industry down. Same with doctors and hospitals. They seem to have no interest in 'policing' themselves.

Let the 'People' see which hospitals and doctors are killing us. Expose the insurance companies who only expend 60-70% of premiums on care and 'redline' patients.





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