Calling all Canadians.................

[enjoy the ride]

I relly want some more information from Canadians on their health system.

What does it cost in taxes? If there problems with waste and fraud, how are the managed? What sort of income do doctors and hospitals get and how are they expected to manage it?

How long has it been in place? What problems have occured and have they be taken care of?

Are law suits a problem? If not, what keeps it from being a problem?

 

[miss_thenorth]

http://en.wikipedia.org/wiki/OHIP

 

[miss_thenorth]

I don't know how much of our taxes go toward OHIP. There used to be a problem with fraud, but now you ar rquird to show your health card prior to servics rendered, and you must rnew your health card every few years (not sure how often exactly)

I don't know how much doctors ar paid or how hospitals are run. I'm sure doctors are paid competitively, just as I'm sure hospitals overcharge for a tylenol, etc.

IFAIK, lawsuits are not a problem. I know of several attempts to sue doctors, but getting anything to stick is difficult.

 

[miss_thenorth]

http://www.settlement.org/sys/link_redirect.asp?doc_id=1003050

 

[enjoy the ride]

So what happens to a person who is illegally in the country and gets sick?
Are doctors prevented from charging more than the insurance pays- are there physicians who practice outside the system?

I'm trying to get an idea of how the national insurance works. I worry that it will be like earthquake insurance here in California- I had good coverage at a reasonable price from my insurer but some people couldn't get any because they live in a place with poor earthquake prognosis. So California instituted a pooled plan managed by the state governement and barred all private plans. Now people who live in a high earthquake damage risk area can get this state insurance, which will be out of money if an earthquake is severe and widespread, and costs so much more for very poor coverage. I went from good coverage and not too expensive to bad coverage costing a lot.

I remember when Medical (medicaid in other places,) was pretty extensive but so many people abused the system (doctors, patients and hospitals,) that it was cut back and back and back til it's hard to find doctors to accept patients. People treated it as a cash cow.

 

[patandchickens]

So what happens to a person who is illegally in the country and gets sick?

There is always the cash-on-the-barrelhead option for them of course, not that most people here illegally would be likely to go that route but some LEGAL aliens do (i.e. people here legally but not eligible for OHIP or other provinces' analogs). I honestly have no idea what happens if you are illegal and show up at the hospital after getting run over by a car. I expect they handle it basically the same way as in the US -- I doubt they would just pitch you out on the curb without treating you -- but don't actually know for sure.

Are doctors prevented from charging more than the insurance pays- are there physicians who practice outside the system?

No, privatization is explicitly prohibited. There is always talk from some quarters, esp. lately, about changing that, but at present you have to go across to the US if you want a doctor that is operating outside the OHIP (etc) system of protocols, regulations, waits, etc.

I'm trying to get an idea of how the national insurance works. I worry that it will be like earthquake insurance here in California- I had good coverage at a reasonable price from my insurer but some people couldn't get any because they live in a place with poor earthquake prognosis. So California instituted a pooled plan managed by the state governement and barred all private plans. Now people who live in a high earthquake damage risk area can get this state insurance, which will be out of money if an earthquake is severe and widespread, and costs so much more for very poor coverage. I went from good coverage and not too expensive to bad coverage costing a lot.

Basically, I think you can summarize the differences between the Canadian system and the American system (in terms of 'how good yoru coverage is') as something like this:

In the US, how good your coverage is relates pretty much to how prosperous you are. The better job and more money you have, the more coverage. Those with no jobs have no, or next to no, coverage at all.

In Canada, how good your coverage is does not depend on anything at all, really -- it is an almost totally level playing field. (Well, unless you are rich enough to go across the border and pay cash-on-the-barrelhead for treatments etc from US sources. But that's not many people). Those with no or low-level type jobs have exactly the same coverage as CEOs of large companies, AFAIK, the only difference being that the CEOs will have supplementary insurance covering things like a private hospital room, prescription drugs, etc (not actual access-to-medical-care issues).

One significant problem in Canada right now is a shortage of doctors, especially in remote areas but even in suburban and urban areas to some degree. The problem is that a) a doctor can make a lot more money in the US etc than here, and b) the process for foreign-trained doctors to get Canadian credentials is abysmally slow and ineffective.

From the perspective of someone who is, say, unable to work because of disability, or working in MacDonald's or waitressing or that sort of thing, the Canadian system is far better because you CAN have all sorts of tests and treatments that you would never have access to in the US or would have to declare bankruptcy after. For instance if someone with low or no income has a child with some sort of expensive medical condition -- during birth, or during childhood -- it is COVERED here.

From the perspective of someone with a pretty good job with pretty good benefits, though, the American system is better, because since the same coverage is spread over EVERYBODY here, wait times can be long (sometimes unacceptably long, like months before chemo for cancer, or a year or years wait for a hip replacement) and the only way to get yourself treated better than everybody else is to pack a suitcase full o money and go across the border to the US. Which, while feasible for the quite rich, is not so feasible for the middle and upper middle class.

If you believe that the middle class is inherently entitled to better health care than the poor or those unable to work, then you would prefer the American system. If you believe that everybody should have the same rights to healthcare, with the dollar going as far as it goes and if that doesn't allow as fancy care to those who would otherwise have "qualified" for fancier care then so be it, then you would prefer the Canadian system.

(Me, I am not generally socialist in politics and I think there are a few areas where the Canadian system could really be improved, but on the whole I think the Canadian system is MUCH MUCH preferable, on the grounds of fairness to all. Even though it is not to *my* benefit, personally)

Note that Canada is not unique. Great Britain, some Scandinavian countries, etc also have government-funded-and-run health care. I gather that some of the systems work better than the Canadian one, in terms of avoiding huge wait times.

JMO,

Pat

 

[enjoy the ride]

I suspect that the US will end up with a compromise system that provides some basic coverage- the real problem is not with the very poor, who have access to free clinics and other assistance programs if they can deal with the paperwork and have the motivation but the people who work but still have no benefits. For them, even getting insurance of any kind at a price that can be paid can be almost impossible. Especially if they have any medical condition.
When this starts being put together in Congress, there is going to be one uuuuggggly feeding frenzy. There are a lot of lobbiest who still have money to be thrown around and so many in Congress have lost all sight of decent principles and values that they no longer know or care that selling their votes is wrong- I'm not even sure that they have the concept anymore that the power of their position is not their personal power to be used for their wants.
It's just a question as to who gets the shaft- and I have the feeling it's going to be the late great middle class.
I know that most doctors's offices have more than one person whose jobs is to try to figure out and get reimbursement from a thousand different insurance plans. That drug companies charge US citizens multiple times what Canadians and Europeans pay for medications.
I'm just afraid that a lot of employers will use this chance too as an opportunty to eliminate medical coverage for their employees too.


By the way, I was surprised to find that Canada has a rural doctor shortage- we do too- rural doctors have too many demands on their time and less income than city docs- so we can't get them either. They try for awhile here then run back to the city. A continuous revolving door.

 

[miss_thenorth]

I hafta sorta disagree with only rural areas having doctor shortages. My parents live in a town, pop.~15000, close to two other cities. They have a doctor shortage. Reason is, I think, b/c there is nothing there to really offer the doctors. For them, wait time to see a doctor is close to a week to get an appt, and then they wait in the office for up to 5 hours to even see the doctor, regardless of what time their appt was.

When I lived up north, waaaay up north, in a remote, rural, small town of 5000, and that population includes surrounding areas of approx 50 km radius, our hospital had three full time doctors. I could get an appt in a day, and wait time was only bad if my doctor was on call, and he was actually called. I am rural right now, and there are two doctors at my clinic who ar still accepting new patients. There is a doctor shortage, but I have never been affected by it. Also, to get specialist appt.'s here, the waits don't seem to be too long. But I know that varies, I think, esp in areas around London and Toronto.

The Canadian system is not perfect, but I have absolutely no complaints. What OHIP doesn't cover, my dh's benefit plan at work covers.

 

[enjoy the ride]

Well we may be different than many areas too- a huge drug population- lots of people without insurance too.
I think our problem is that doctors don't stay- they come but frequently leave again shortly.

 

[patandchickens]

I hafta sorta disagree with only rural areas having doctor shortages.

Actually I don't think anyone has said that -- I know I was careful to specify that suburban and urban areas often ALSO have shortages.

Heck, here in Uxbridge, a decent-sized town which now has largely a fairly well-off commuter population, we are "supposed" to have IIRC 14 or 15 doctors (based on OHIP's per-capita formula) but in reality have I think 10 or 11 at the moment. MANY MANY canadians do not have a regular family doctor and are stuck with just going to a walk-in clinic if there's a problem (which is ok if you are, like, basically healthy and have just a passing problem, but if you have chronic issues it is REALLY REALLY unsatisfactory). I myself have to drive 35 minutes each way to the family dr we use, and consider myself lucky to have gotten into her enrollment at all (happened to be looking at just the right time)... there are lots of people around here who *haven't* got one.

I would think that both the poor and the 'working poor' would benefit from a Canadian-style system... I mean, OHIP (and other provinces' versions) covers lots and lots of stuff that I don't *think* (?) is accessible under current US conditions. All expenses paid maternity, labor-and-delivery bills (in Ontario, the province even covers MIDWIFE care if you want it, including qualified homebirths, how cool is that!) and neonatal intensive care; and hip and knee replacements, pacemakers, cancer surgery, etc.

I am honestly not certain what sorts of benefits are typical of middle-class employer health plans (I was always basically healthy when I was working in the US and thus never really paid any attention to all the health plan fine print, tho prolly I shoulda) but I would not be surprised if it's about even-steven with the Canadian system benefits, or Canadian system possibly a bit better if you ignore wait-time issues. (And the wait time thing seems to be more a Canadian idiosyncrasy than an unavoidable feature of socialized healthcare)

The upper middle class and rich are clearly, IMO, better off with the American system, from a purely selfish viewpoint anyhow.

I am entirely with you though, etr, in worrying that universal healthcare is likely to be very, very, very poorly implemented if it happens in the US, full of boondoggles and rackets and profitmaking loopholes :/

Pat