Health Care for Everyone

[mustafur]

Can someone please explain to me what is complicated about a Single payer system.

One payer, bulk price and lower costs.

Ofcourse if you go into the public option route then your adding complication.

 

[Danoff]

Renouncing their US citizenship.
That does not qualify for entrance to Canada.

I didn't say it was. I said this:

The plan was to renounce US citizenship and become a Canadian citizen after immigration to Canada.

We are not a Socialist country. Please don't even assume we are.

Well, socialist is as socialist does. You are a socialist country (and so is the US) to the extent that you have socialist policies like universal healthcare. But... I thought it was clear I was speaking for someone else. So for example, I said:

This person is a staunch socialist, and advocate of universal healthcare, currently living in the US but searching for a way to leave the fascist misogynistic trump dictatorship in favor of a more civilized socialist nation.

See how I'm describing someone else's view there?

Healthcare in Canada is not free as my tax dollars pay for my health care. It is not a free for all system.

You're preaching to the choir. But preach on brother!

But to answer your question,yes some of it is covered. Not that I agree with it,but it is. When they get blood work,they will still be a Male no matter what changes they have.
http://www.health.gov.on.ca/en/pro/programs/srs/

So my understanding is that the waiting line for this is extreme. Or perhaps it was the waiting line for hormone treatment, I'm actually not sure which. Ironically, the universal healthcare system covering it could be very bad for transgender folks, because then it (based on my understanding of the Canadian healthcare system) becomes illegal for other clinicians to provide those services. So, as with everything else "covered", you either get in line or you get nothing.

Not from Canada But does she herself think about universal healthcare not covering it? And is the out of pocket cost the same or lower/higher then us?

Well out-of-pocket is not necessarily the final measure (and this is something that I just cannot seem to get through to universal healthcare advocates). Sometimes people don't want to wait until their lives are gone to get "free" healthcare. I don't know what out of pocket costs are, but if Canada even allows out of pocket payment for such treatment (see above for why that might not be the case), she wants to get on with her life as a woman now, not years from now when her number finally gets pulled (if it's still being offered then).

My guess is that out of pocket in the US is better than or similar to out of pocket in Canada (if that's a thing), simply because out of pocket in Canada is competition for out of pocket in the US. I did not ask about US insurance coverage. From a sampling of insurance providers in the US, it seems like hormone therapy and gender reassignment surgery are covered under insurance uh.... sometimes... in certain circumstances. As always with insurance it seems.

People need to differentiate between a social democracy and a socialist nation. Using these 2 as they are the same, is causing confusion.

They absolutely do given that those two things are not even in the same ballpark. One is a system of inputs (votes) to the government, and the other attempts to describe outputs (services) from the government. In terms of services, "socialist" is a very nebulous term that simply describes how a government appears to function based on its programs. If you have a fair number of socialist services, you might get called socialist. Words.

Can someone please explain to me what is complicated about a Single payer system.

One payer, bulk price and lower costs.

Ofcourse if you go into the public option route then your adding complication.

Single payer is usually associated with the "public option". So I'm a little lost on that. Can you explain what a single payer system is? At least in your view. I believe Australia is not one.

Edit:

Seems to me that any large scale, monopolistic organization, whether private or public, tends to have the pluses & minuses of economies of scale ... & bureaucratic inefficiencies. The numbers seem to indicate that in the US the balance of those pulses & minuses is not positive, as the US spends way more per capita than countries with universal payer systems, but does not have better results.

If you just look at cost in for services out, you have a point. It's not the only thing to look at.

 

[Joey D]

Can someone please explain to me what is complicated about a Single payer system.

It's the government. The government does nothing efficiently and the amount of red tape is going to be astronomical no matter what.

 

[PocketZeven]

Well out-of-pocket is not necessarily the final measure (and this is something that I just cannot seem to get through to universal healthcare advocates). Sometimes people don't want to wait until their lives are gone to get "free" healthcare. I don't know what out of pocket costs are, but if Canada even allows out of pocket payment for such treatment (see above for why that might not be the case), she wants to get on with her life as a woman now, not years from now when her number finally gets pulled (if it's still being offered then).

My guess is that out of pocket in the US is better than or similar to out of pocket in Canada (if that's a thing), simply because out of pocket in Canada is competition for out of pocket in the US. I did not ask about US insurance coverage. From a sampling of insurance providers in the US, it seems like hormone therapy and gender reassignment surgery are covered under insurance uh.... sometimes... in certain circumstances. As always with insurance it seems.

I dont really see the Irony though. Without really knowing the details, you did suggest Canadian healthcare does not exclude coverage. Just there is a waiting list. Is it months, years?

 

[Danoff]

I dont really see the Irony though. Without really knowing the details, you did suggest Canadian healthcare does not exclude coverage. Just there is a waiting list. Is it months, years?

Dunno. Long enough to foreclose Canada as an option, and that is the irony. To her the US is a backward intolerant place that refuses to support transgender people and refuses to provide healthcare. And the reason she can't go to Canada is because the US is where she can get the transgender healthcare she needs.

Don't see the irony? Yea, she doesn't either unfortunately. That fact that she could do the things she wants to do, and be the person she wants to be here in the US will unfortunately convey absolutely zero sense of a supportive healthcare system, or support for transgender people.

 

[PocketZeven]

Dunno. Long enough to foreclose Canada as an option, and that is the irony. To her the US is a backward intolerant place that refuses to support transgender people and refuses to provide healthcare. And the reason she can't go to Canada is because the US is where she can get the transgender healthcare she needs.

Don't see the irony? Yea, she doesn't either unfortunately. That fact that she could do the things she wants to do, and be the person she wants to be here in the US will unfortunately convey absolutely zero sense of a supportive healthcare system, or support for transgender people.

Does she really think that the US is intolerant, compared to Canada?

 

[Danoff]

Does she really think that the US is intolerant, compared to Canada?

Yes, absolutely.

 

[VFOURMAX1]

Dunno. Long enough to foreclose Canada as an option, and that is the irony. To her the US is a backward intolerant place that refuses to support transgender people and refuses to provide healthcare. And the reason she can't go to Canada is because the US is where she can get the transgender healthcare she needs

Was this "SHE" actually born a "HE"?

 

[Danoff]

Was this "SHE" actually born a "HE"?

An extended-family member of mine recently came out as transgender, currently undergoing hormone therapy to transition to female.

Pronouns are so loaded these days - to the point where I have trouble even answering this question. This person has a Y chromosome. I think that's what you're getting at, but that's not changing. If one presumes that the he/she pronoun should be decoupled from chromosomes, then one might suggest that my relative has been misidentified as a 'he' but was actually born a 'she' and that is not changing either.

Formerly known as male I suppose. Male to Female Transgender.

 

[VFOURMAX1]

Pronouns are so loaded these days - to the point where I have trouble even answering this question. This person has a Y chromosome. I think that's what you're getting at, but that's not changing. If one presumes that the he/she pronoun should be decoupled from chromosomes, then one might suggest that my relative has been misidentified as a 'he' but was actually born a 'she' and that is not changing either.

Formerly known as male I suppose. Male to Female Transgender.

The reason I ask is that the "therapy" or procedures that this person desires is not needed for any physical health issues or to medically improve their life or lessen the risk of death.

These procedures are just I want as far as life or death is concerned and should be treated as any other cosmetic elective period.

In these cases I think any procedures or drug induced "therapies" done should be at the full expense of the individual requesting such procedures or treatments. No different than cosmetic surgery like breast implants or a butt or face lift.

Expecting someone else to pick up part of the tab, whether it be insurance or government funded healthcare should be laughable to begin with.

 

[Joey D]

The reason I ask is that the "therapy" or procedures that this person desires is not needed for any physical health issues or to medically improve their life or lessen the risk of death.

When it comes to gender dysphoria, it is a recognized medical condition and is treated with hormone replacement therapy as well as talk therapy. The cosmetic procedure isn't part of that treatment though. So really, if insurance is going to cover medically necessary treatments, then it should cover HRT as well as talk therapy. I believe most insurance companies do under the umbrella of mental healthcare.

 

[Danoff]

The reason I ask is that the "therapy" or procedures that this person desires is not needed for any physical health issues or to medically improve their life or lessen the risk of death.

Well that's not true. People do commit suicide over this issue. You're downplaying mental health.

 

[TenEightyOne]

universal healthcare does go hand in hand with criminalizing alternatives

How so? I'm not disagreeing (yet ), just interested. The UK has no problem with a National Health Service alongside fully private hospitals.

No different than cosmetic surgery like breast implants or a butt or face lift.

I think that such a comment could demonstrate an utter lack of understanding on the issue - you're thinking of men who decide to look like women, not women who've lived in a man's body all their life. Try to see it the second way.

 

[VFOURMAX1]

Well that's not true. People do commit suicide over this issue. You're downplaying mental health.

No, I am not downplaying the problem which you have actually brought to the forefront with your comments. MENTAL HEALTH is the issue and should be treated for what it is mental issues or deficiencies and efforts should be to correct the problem not catering to continuing or furthering the delusion and pretend world this person prefers to reside in at the expense and cost to the healthcare system for these individuals to pretend they are something they can never be or should be.

I think that such a comment could demonstrate an utter lack of understanding on the issue - you're thinking of men who decide to look like women, not women who've lived in a man's body all their life. Try to see it the second way

Whether you like it or not gender is decided and assigned before actual birth, you are born either a male or female period and all the pretend that you dedicate to the issue does not change that fact at any point during that persons life. It is not about understanding other than the understanding that the people that have a problem with their gender is the actual problem is mental issues not physical ones and the mental issues should be addressed to bring the person back to the reality of their gender at birth not some pretend world their mind wants to place them.

This is not the P/C attitude most want to hear in today's world but it is still the facts. You put lipstick on a pig well you still have a pig just like you put a dress on a male you still have a male.

 

[TenEightyOne]

You put lipstick on a pig well you still have a pig just like you put a dress on a male you still have a male.

Do you believe you are male? Do you feel male?

 

[G.T.Ace]

This is not the P/C attitude most want to hear in today's world but it is still the facts

Science disagrees with you.

 

[MatskiMonk]

This is not the P/C attitude most want to hear in today's world but it is still the facts.

Edgy. What's next, beating the gay out of people?

 

[VFOURMAX1]

Do you believe you are male? Do you feel male?

Really makes no difference if I look in my underwear the facts are I am a male whether I prefer to be or not to be.

Science disagrees with you

Science has not in my experience has never seen a person born with strictly male organs birth a child as a female or even have that ability to make that choice due to the lack of possessing a working female reproductive regardless whether the mental health issues makes that person want to be a female. That pretty much ends the debate of gender from strictly a physical and scientific point of view.

Science in many aspects are sort of like political polls, depends on who you ask or which of many different studies you want to quote.

This week eating eggs is bad for you, next week there are health benefits from eating eggs, do not believe everything you see. When it comes to mental health you in many cases are just hearing that persons or doctors opinion, nothing more or nothing less. Sort of like religion some see it one way. some another.

Edgy. What's next, beating the gay out of people?

Never said anything of the sort, just that the health care system or health insurance system should not bear any of the expense of hormone or gender reassignment therapy that ends up costing all patients.

You want to live a life of such then go do it, only at just your own expense.

 

[Famine]

Really makes no difference if I look in my underwear the facts are I am a male whether I prefer to be or not to be.

Cool.

Let's talk about intersex syndromes, chromosomal gender, and mosaicism. In the appropriate thread.

Science in many aspects are sort of like political polls, depends on who you ask or which of many different studies you want to quote.

This week eating eggs is bad for you, next week there are health benefits from eating eggs, do not believe everything you see. When it comes to mental health you in many cases are just hearing that persons or doctors opinion, nothing more or nothing less. Sort of like religion some see it one way. some another.

That's politics, not science.

 

[MatskiMonk]

Never said anything of the sort, just that the health care system or health insurance system should not bear any of the expense of hormone or gender reassignment therapy that ends up costing all patients.

It's the fact that you see it as nothing more than a choice.

Besides that, it's only one thing on a very long list of reasons why people end up costing the healthcare system that are a direct result of choices they make. Child birth isn't cheap, sports injuries aren't cheap, illnesses and accidents related to alcohol aren't cheap, and all of them are the result of people making a choice to do what they want.

 

[Danoff]

I tried to take @VFOURMAX1's transgender position to the transgender thread.

How so? I'm not disagreeing (yet ), just interested. The UK has no problem with a National Health Service alongside fully private hospitals.

It creates a two-tier system, which is why Canada made it illegal to charge for any service offered by the national system. They didn't want a system of haves and have-nots, exactly the sort of thing that causes universal healthcare in the first place. So while some systems might exist with both a national system and private system alongside (I think Australia is an example), I do wonder how stable that is. The same rationale that lends itself to creating a universal healthcare system lends itself to preventing a private one alongside.

I'll grant that this is not black and white. I'm just saying that it is intertwined, they hold hands.

 

[Sander 001]

I tried to take @VFOURMAX1's transgender position to the transgender thread.



It creates a two-tier system, which is why Canada made it illegal to charge for any service offered by the national system. They didn't want a system of haves and have-nots, exactly the sort of thing that causes universal healthcare in the first place. So while some systems might exist with both a national system and private system alongside (I think Australia is an example), I do wonder how stable that is. The same rationale that lends itself to creating a universal healthcare system lends itself to preventing a private one alongside.

I'll grant that this is not black and white. I'm just saying that it is intertwined, they hold hands.

source?

 

[Danoff]

source?

Here's a little.

In other words, the ages-old debate about user fees is back with a vengeance. So, too, is the perennial angst about "two-tier" health care. The politics and history of the user-fee debate is dense and complex. The rhetoric about "extra-billing" is often suffocating. But, when you cut through all of that, the remaining question is pretty straightforward: What is covered by public funding and what is not?

Related: Cutting through the numbers on health-care funding

Opinion: How much should Ottawa spend on health? It's complicated


Read more: Five things Canadians get wrong about the health system


Unfortunately, the answer is not at all clear, especially around the periphery.

Under the terms of the Canada Health Act, no user fees are permitted for "medically necessary" health services, which are defined, vaguely, as hospital care and physician services. That does not mean user fees or extra billing are illegal; it means that, if they are charged, Ottawa can claw back from provincial health transfers an equivalent amount. But that clause of the law has not been enforced for more than a decade, because the previous Conservative government did not believe Ottawa had a role to play in determining how health care is delivered.

Also more here:

Six of Canada's ten provinces used to ban private insurance for publicly insured services to inhibit queue jumping and so preserve fairness in the health care system. In 2005, the Supreme Court of Canada ruled that in Quebec, such bans are unconstitutional if the waiting period for care is excessively long. However, this ruling only applies within the Province of Quebec. A second court challenge is currently underway to determine whether the prohibition of private parallel health care violates the patients' right to life, liberty, and security under Section 7 of the Canadian Charter of Rights and Freedoms.

Some private hospitals operating while the national healthcare plan was instituted (for example, the Shouldice Hernia Centre in Thornhill, Ontario) continue to operate, but they may not bill additional charges for medical procedures. (The Shouldice Hospital, however, has mandatory additional room charges not covered by public health insurance. That effectively places it in the "upper tier" of a two-tier system. Welfare recipients, for example, cannot be referred there.)

Clinics are usually private operations but may not bill additional charges. Private healthcare may also be supplied, both in uncovered fields and to foreigners.

It's messy. The effect is that, at least for much of Canada, if the service is part of the national system, you wait in line. The concept of a two-tier system is not popular with everyone, but it is finding holes in the law to poke its way in where possible. That should be expected.


Edit 2:

Also really makes my point that they're overturning some of these rules because of how excessive the waiting lists have become in the Canadian system. The backlash that it's not fair for people with money to bypass the line is immediate and potent with voters.

Anyway, let's bring this all back around. So the system "works" in Canada. Picture exaggerated air quotes with rolling eyes.

 

[Danoff]

If you say so, although I don't recall joining in with this barrage. As far as I'm concerned you're welcome to your health system. I'm pretty sure I can match your anecdotal data with anecdotes of people coming to Britain to use universal healthcare. And our relative happiness may be illegitimate in your eyes, but if this graph is anything to go by than it's not just foreigners who are very dissatisfied with the US healthcare system. A slightly larger fraction of people may be very happy with it in the US than in Canada or the UK, but I don't think there's any great movement in either of those countries to pass legislation to change those countries' health systems any time soon. Dissatisfied Americans may want to create memes that complain about their health system but I don't think other countires are following suit.

View attachment 881475

I'm realizing that there are some cultural issues here, or at least there appear to be. You seem to think that if the system makes more people happier, it's better (the utilitarian approach). And from my perspective, if it leaves even a small number of people without options, it's unacceptable. So the fact that lots of people are happy with it doesn't really affect me. If I can see a hole to fall down, I'm not a fan.

There are traps in the US "system" too. But the traps can be overcome with money. I know that might sound unfair to you, or the exact definition of the problem. But to me, it sounds like options - a way out. Even if it means getting charitable assistance. This is why I especially don't like the Canadian flavor of universal healthcare, because it can leave you with no options.

 

[Rallywagon]

I'm realizing that there are some cultural issues here, or at least there appear to be. You seem to think that if the system makes more people happier, it's better (the utilitarian approach). And from my perspective, if it leaves even a small number of people without options, it's unacceptable. So the fact that lots of people are happy with it doesn't really affect me. If I can see a hole to fall down, I'm not a fan.

There are traps in the US "system" too. But the traps can be overcome with money. I know that might sound unfair to you, or the exact definition of the problem. But to me, it sounds like options - a way out. Even if it means getting charitable assistance. This is why I especially don't like the Canadian flavor of universal healthcare, because it can leave you with no options.

Soooo, what about disqualifying preconditions? I mean you say "if it leaves even a small number of people without options" then surely we cannot point at our healthcare system and say "yup, that's good" or even better than systems like Canada or the UK. Our insurance companies go out of their way to get out of covering people for a wide range of reasons, and even a normal dr. visit can cost a thousand or more, 10s of thousands if an issue requires any sort of hospitalization. I mean, cool, if you have the money, but that's kinda the point of insurance right? Cause 99% of us dont exactly have the money to cover medical emergencies that can cost as much as a new car. Surely that fails your "if it leaves even a small number of people without options" test?

 

[Danoff]

Soooo, what about disqualifying preconditions? I mean you say "if it leaves even a small number of people without options" then surely we cannot point at our healthcare system and say "yup, that's good" or even better than systems like Canada or the UK. Our insurance companies go out of their way to get out of covering people for a wide range of reasons, and even a normal dr. visit can cost a thousand or more, 10s of thousands if an issue requires any sort of hospitalization. I mean, cool, if you have the money, but that's kinda the point of insurance right? Cause 99% of us dont exactly have the money to cover medical emergencies that can cost as much as a new car. Surely that fails your "if it leaves even a small number of people without options" test?

I think the healthcare system in the US sucks. But no, not having the money doesn't fall into the "leaves people without options" category for me. Because charity, including medical charity, is well established in the US, and having the money is generally an option. Precisely what people are trying to do in Canada is to prevent people from doing anything except waiting their turn. If you think you need a procedure that is covered in Canada, and they disagree, you're SOL.

Our insurance nightmare in the US is partly created by our government, and is one of the big drivers for medical costs in the US. It's not a good system, it needs heavy reform.

You have to understand, when I say no options, I really mean no legal options. Not like "it's hard" or, "it would take a lot of help". I mean, "you do this and people go to jail". Back alley abortions are not "an option", for example. But an expensive abortion is.

Edit:

And I don't consider medical tourism to be "an option" in the same regard, because that's really trying to have your cake an eat it too. It's like saying "yea our laws suck, but other countries' laws don't suck and so our laws are fine because you can just go there". If they change their laws to match yours, your system fails.

Besides that, I could even see Canadians arguing that it should be illegal to leave the country for medical procedures that are covered because it enables people with money to "skip the line" and that's not fair.

 

[Sander 001]

Here's a little.

Also more here:




It's messy. The effect is that, at least for much of Canada, if the service is part of the national system, you wait in line. The concept of a two-tier system is not popular with everyone, but it is finding holes in the law to poke its way in where possible. That should be expected.


Edit 2:

Also really makes my point that they're overturning some of these rules because of how excessive the waiting lists have become in the Canadian system. The backlash that it's not fair for people with money to bypass the line is immediate and potent with voters.

Anyway, let's bring this all back around. So the system "works" in Canada. Picture exaggerated air quotes with rolling eyes.

"Works" as in people aren't being bankrupted into medical debt and dying? Well yes actually.

The hole in your argument is that you're fixated on insurance mostly. Bottom line: You can still visit private healthcare services and pay for whatever procedure you want/need.

 

[Danoff]

The hole in your argument is that you're fixated on insurance mostly. Bottom line: You can still visit private healthcare services and pay for whatever procedure you want/need.

Holy crap...

Ok so at least you're conceeding that private health insurance is banned (for nearly all of Canada). But this is not enough for you, so let's take it a step further. Let's say you want to offer an out-of-pocket (because insurance is banned) private clinic that offers the same services as those provided by the national system. You can technically legally do that, but only if you stay under the national system cost cap. That cost cap is not put in place to keep you from over-charging, you're allowed to overcharge (the over charge amount gets clawed back by the national system, so they want you to feel free to soak your customers). The cost cap is put in place to make sure that the national system is not at a disadvantage for hiring doctors, as a result, whatever remains is quite sketchy.

This is why if you want to bypass the line, you're into medical tourism.

 

[Joey D]

"Works" as in people aren't being bankrupted into medical debt and dying? Well yes actually.

The hole in your argument is that you're fixated on insurance mostly. Bottom line: You can still visit private healthcare services and pay for whatever procedure you want/need.

There's no reason for anyone to go bankrupt due to medical expenses. I'm now working at my third different health system and over the past 10 or so years, I've probably worked at something like 20 or more hospitals. Every single one of them offers financial help and if you meet certain conditions, you get your entire bill written off. Most health systems only require patients to pay a nominal amount each month too, where I work now it's $25 a month. If you can't manage $25 a month, then we have a whole team of people that will get your connected with services to help you.

Also, every health system I've worked at has numerous community outreach programs. These are always free and focus on preventative medicine and education. This is a great, free way to get things like lab tests, vaccinations, and other things done without ever paying a dime.

Yes, there are many flaws in the healthcare system in the US. One of the biggest issues is how terrible Medicaid and Medicare are run and how their regulations bleed into treating patients with private insurance. The sheer number of tests needed to arrive at a diagnosis is insane, even for something simple like an ACL tear. When I ended up spraining my ACL, I needed an appointment with my primary, then a referral to a specialist, who then had me get an MRI and X-rays. After that, I had to do several weeks of physical therapy followed by another MRI. After all that I finally got a cortisone injection to "fix" my issue. All of this was completely unneeded since even my primary said I sprained my ACL, but the insurance wouldn't approve the injection without a bunch of other needless tests. This is thanks largely in part to how Medicaid and Medicare operate since most private insurances just follow the same basic outline of care.

On top of all this, the cost of malpractice insurance is astronomical which is due in part to a society that loves to sue. This drives up the cost of care as well.

Basically, we've ended up with a broken healthcare system because the government allows, and in some cases demands, it to be broken. Also, we have a society that doesn't care about its health for the most part.

 

[Eunos_Cosmo]

Automate health care.

Job done.

Sorry @Joey D