Health Care for Everyone

[Sander 001]

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.

Whatever remains is quite sketchy?

From your own link: "Canada has a publicly funded health care system, but the vast majority of doctors do not work for the government. A patient is free to choose which doctor they wish to visit, and they are entitled to essential physician health services without charge. Doctors are self-employed"

 

[Joey D]

Automate health care.

Job done.

Sorry @Joey D

Weirdly, we're trying to do that and all it's doing is making jobs like mine even more important.

Right now if an organization is on one of the larger electronic medical records they can automate large parts of a patient's visit and it's statistically safer than just using a human by themselves. As of right now, EMRs can cross-check allergies, check for drug interactions, and determine proper dosing based on a patient's vitals. Also for doctors, people like me can build a note template that essentially checks all the boxes for proper billing and all the doc needs to do is click a few buttons and verify the information is correct.

There are other things like massive predictive databases that you can connect into to determine everything from the likelihood of cancer to whether or not the patient will no show for their appointment. It's all shockingly accurate too and is something I'm currently working with. It impresses me every time I run queries.

The biggest problem we face though is older doctors who refuse to use these tools and insist on using paper charts. This slows the process down substantially and allows for way more errors, and thus increases costs. Past that, you have older doctors get into hospital administration and then dictate that the old technophobe doctors don't have to conform. On the back end, you have people like coders who've done the same job for 40 years and the hospital refuses to get rid of them despite them being slower and less accurate than a computer system. Essentially we're in a weird transition time that should change over the next 10-15 years.

I long for the day healthcare is automated and there's just a handful of people like me behind the scenes keeping the cogs oiled.

 

[TenEightyOne]

About as misleading as you can be at this point.

I know nothing about Canada's healthcare system, do you have some examples of services that have been found to be illegal because they were already offered by the national health system?

In the UK the only things that are illegal are practices by unlicensed practitioners, practices that involve things outlawed on safety grounds or practices about which unsubstantiated health claims are made. I guess the majority of those found to be breaking the law are offering cosmetic procedures like tooth bleaching, bum lifting, flap trims and the like.

We have private hospitals run by health companies (e.g. Nuffield, BUPA) that can perform the majority of the procedures that the NHS can offer, their consultants are often working for both the NHS and the private health sector. There is no illegality in private health companies unless they contravene the law in one of the ways I described above. That's why I find it hard to imagine that universal health care goes "hand in hand with criminalizing alternatives".

 

[Danoff]

Whatever remains is quite sketchy?

From your own link: "Canada has a publicly funded health care system, but the vast majority of doctors do not work for the government. A patient is free to choose which doctor they wish to visit, and they are entitled to essential physician health services without charge. Doctors are self-employed"

Public system doctors are self-employed. They bill the national system. You're not free to choose which doctor you ultimately visit, you have to go through a primary care physician and get a referral. If you want access to a specialist within the national system, you must go through the gatekeeper. Their job is to control who gets access to what specialists. But you do have some degree of control over your PCP, which is why they say "free to choose", although measure are considered to limit your choices further on that front.

 

[Danoff]

I know nothing about Canada's healthcare system, do you have some examples of services that have been found to be illegal because they were already offered by the national health system?

How many times do I have to... ok... once more as always.

The Canada Health Act, which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government, does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. This does not constitute a ban on privately funded care; indeed, about 30% of Canadian health expenditures come from private sources, both insurance and out-of-pocket payments.[125] The Act does not address delivery. Private clinics are therefore permitted, albeit subject to provincial/territorial regulations, but they cannot charge above the agreed-upon fee schedule unless they are treating non-insured persons (which may include those eligible under automobile insurance or worker's compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding.

In 2006, the Government of British Columbia threatened to shut down one private clinic because it was planning to start accepting private payments from patients.[126] Since 2008, Dr. Brian Day has been suing the British Columbia government on the basis that the Canada Health Act is unconstitutional. In 2016, the Government of Quebec was sued for passing Bill 20, which allows and regulates add-on fees.[127][128]

"Insured persons" here means people covered by the national system, and "insured services" means services offered by the national system. For more on that, see here:

Medicare (French: assurance-maladie) is an unofficial designation used to refer to the publicly funded, single-payer health care system of Canada. Canada does not have a unified national health care system; instead, the system consists of 13 provincial and territorial health insurance plans that provide universal health care coverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government.[1] The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.

If you're covered, and it's covered, you shall not be charged. Anyone attempting to offer those services must do so through the national system requirements.

 

[Sander 001]

You're not free to choose which doctor you ultimately visit,

Wrong again

"For the record: Canadians pick their own doctors, just like Americans do."

https://ourfuture.org/20080204/mythbusting-canadian-health-care-part-i

 

[Danoff]

Wrong again

"For the record: Canadians pick their own doctors, just like Americans do."

https://ourfuture.org/20080204/mythbusting-canadian-health-care-part-i

Misleading again.

You have to go through your primary care physician to get access to a specialist at the national insurance rate. Good luck getting a specialist without a referral, they're penalized for even accepting you unless you go through your gatekeeper.

THE UNITED STATES HEALTH CARE SYSTEM:
Primary care physicians account for approximately one-third of all US doctors. They do not have a formal gatekeeping function for providing referrals to specialists or other health care service providers.

Patients have free choice of doctor, but often choose based on whether that doctor falls “in-network” with their health insurance provider. Physicians are typically paid through negotiated fees with private insurers, capitation through private insurers, or set fees through public insurance (or some combination of these). Patients are usually responsible for some portion of physician payment, unless the patient is uninsured and qualifies for waived or reduced fees.

THE CANADIAN HEALTH CARE SYSTEM:
Approximately half of practicing physicians in Canada are GPs. They act largely as gatekeepers for health care services, referring patients to specialists as needed. In fact, specialists receive lower fees for non-referred consultations.

Generally, patients have free choice for their primary care doctor, with some requirements for patient registration, which varies by province or territory. Physician fees are paid based on fee schedules that are negotiated by provincial and territorial ministries of health, with financial incentives sometimes linked to performance depending upon the province. Patients are not directly responsible for physician payment as long as the health care services are covered by the universal health care plan.

Non-referred consultations include things like meeting a specialist in the ER. Oh, but it's just like the US system because in the US you get to pick your doctor, and in Canada you get to pick your gatekeeper.

 

[Jump_Ace]

I'm all for healthcare. I lost $300 out of my paycheck a few years back when Obamacare was implemented. This is because my company at the time gave a kick back for not being on their health plan (I am still on my wife's). But I was more than happy to give up that money so that others can have healthcare.

Our first son suffered a stroke at birth, no fault of our own of course. But the subsequent bills that followed with the next 6 months were well over $150,000 and continued from there (at a much slower pace). All of the recommended botox treatments for his right hand and ankle/foot, the MRI and CAT scans, the month long stay in ICU, it all added up fast.

It was definitely the worst day of my life to see my son born with his left arm as white as the Google homepage because the umbilical cord was wrapped around his neck the night before the early morning birth. To then suffer a stroke on the right side (lucky his left wan't affected), get life flighted to another hospital where I had to tell the doctors what I saw. Then they turn around and ask if they should treat the bleeding clot in his brain and risk further brain bleeding (it wasn't a LOT but, 'some'), or do nothing and see if the clot heals since its small. I said to do nothing and it was the right call.

Without my wife's awesome health plan, we would've had to claim bankruptcy, sell our home and wouldn't have been able to afford a second child.

So yeah, yay healthcare!

In my eyes, those who are against healthcare can't put themselves in other people's shoes or don't care to think about experiences like mine. Which is sad, but like it was mentioned before, this country doesn't care about health. Never you mind the stories about Jesus healing people. SMH.



Jerome

 

[FPV MIC]

The system in Canada is very odd to me, and should not be used to base opinions on all universal health care systems.

I've said before in this thread how different it is in Australia (I think UK is similar?):

I find this all a little odd. We have a healthcare system here in Australia where everything is almost free. If you're in need of hospital care it is free. For non-life threatening surgery there's always a waiting list (like Canada), but if you don't want to wait you can choose not to and pay a surgeon of your own choice, in a hospital of your choice, and skip the cues completely (like America). Or you can choose private health care and not have to deal with the public system at all, depending on your level of cover. Can't this be done in Canada without having to leave the country?

We can also go overseas for surgery with no fear of prosecution, and those that choose the Private option get tax breaks.

 

[Sander 001]

Misleading again.

You have to go through your primary care physician to get access to a specialist at the national insurance rate. Good luck getting a specialist without a referral, they're penalized for even accepting you unless you go through your gatekeeper.




Non-referred consultations include things like meeting a specialist in the ER. Oh, but it's just like the US system because in the US you get to pick your doctor, and in Canada you get to pick your gatekeeper.

For a specialist. Patients often think they need a specialist or have no idea what kind of specialist they need so using a GP is better.

And again, if you want to bypass all that, private healthcare is always available if you want to pay.

 

[Danoff]

For a specialist.

ie: selected Doctor

Patients often think they need a specialist or have no idea what kind of specialist they need so using a GP is better.

Those idiots.

And again, if you want to bypass all that, private healthcare is always available if you want to pay.

It's not. If you're covered, and it's covered, the closest you can get a is a private clinic operating under the national system regulations (including the national system fees).

Here's more

8. Pay out of pocket
Seven years ago, Chapman went into the hospital to have a baby and came out needing reconstructive surgery. She was in debilitating pain, but the specialist advised her to wait six months to see if things got better.

When her condition continued to deteriorate, Chapman sought medical attention in another country. Chapman paid $3,500 (not including flights) for a consultation and tests at Johns Hopkins Bayview Medical Center in Baltimore, MD. After getting a diagnosis, she went back to Canada and got the surgery she desperately needed.

If you can afford it, says Chapman, paying for tests privately allows you to skip a step. And you don't necessarily have to go out of the country. Access to private health care varies from province to province. New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary. British Columbia and Alberta each have 60 or more clinics, some of them performing multiple types of surgery. And Quebec, the private-health-care capital of Canada, has more than 300 providers. For information on options, check out findprivateclinics.ca.

 

[Sander 001]

ie: selected Doctor



Those idiots.



It's not. If you're covered, and it's covered, the closest you can get a is a private clinic operating under the national system regulations (including the national system fees).

You're contradictory to your own link.
Did you read your own sources?

 

[Danoff]

You're contradictory to your own link.
Did you read your own sources?

8. Pay out of pocket
Seven years ago, Chapman went into the hospital to have a baby and came out needing reconstructive surgery. She was in debilitating pain, but the specialist advised her to wait six months to see if things got better.

When her condition continued to deteriorate, Chapman sought medical attention in another country. Chapman paid $3,500 (not including flights) for a consultation and tests at Johns Hopkins Bayview Medical Center in Baltimore, MD. After getting a diagnosis, she went back to Canada and got the surgery she desperately needed.

If you can afford it, says Chapman, paying for tests privately allows you to skip a step. And you don't necessarily have to go out of the country. Access to private health care varies from province to province. New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary. British Columbia and Alberta each have 60 or more clinics, some of them performing multiple types of surgery. And Quebec, the private-health-care capital of Canada, has more than 300 providers. For information on options, check out findprivateclinics.ca.

Open up just a tiny bit to what's being explained to you.

 

[Joey D]

Without my wife's awesome health plan, we would've had to claim bankruptcy, sell our home and wouldn't have been able to afford a second child.

So yeah, yay healthcare!

In my eyes, those who are against healthcare can't put themselves in other people's shoes or don't care to think about experiences like mine. Which is sad, but like it was mentioned before, this country doesn't care about health. Never you mind the stories about Jesus healing people. SMH.

While what you went through is awful and something no parent should ever have to endure, you can rest soundly knowing you wouldn't have gone bankrupt without insurance. I presume your little one ended up at a pediatric hospital (my guess is Doernbecher Children's) and that's a non-profit. Basically you would've ended up paying small sums of money for a really long time before the hospital finally just wrote it off. Where I work, we write off millions each month for people that can't afford their healthcare, especially when it comes to kids.

The only time you're really ever going to go bankrupt by going to the hospital is if you end up at a for-profit institution. I am staunchly against for-profit health systems because I see the practice as unbelievably shady and predatory.

 

[FPV MIC]

Open up just a tiny bit to what's being explained to you.

If you can afford it, says Chapman, paying for tests privately allows you to skip a step. And you don't necessarily have to go out of the country. Access to private health care varies from province to province

Seems to me you and @Sander 001 are both right (or wrong) depending on what province you live in.

 

[TenEightyOne]

Open up just a tiny bit to what's being explained to you.

It seems that isn't the case all across Canada and that there are differences depending on where you are. Given that it isn't the case all across Canada and that there other countries (e.g. UK, Australia) where a private health sector works perfectly well alongside the national sector I don't think your implication that illegality of private healthcare is an automatic given when universal healthcare exists is accurate.

EDIT: It's normal for UK citizens to go abroad for some procedures and for other EU nationals to come here. If a hospital specialises in using certain equipment that costs A Zillion Pounds but there's only a call for use on 500 patients a year across Europe then that kind of centralisation makes sense. If a hospital is 100 miles away and has the specialism you need then it doesn't matter if it's in another country - usually.

 

[Joey D]

You have to go through your primary care physician to get access to a specialist at the national insurance rate. Good luck getting a specialist without a referral, they're penalized for even accepting you unless you go through your gatekeeper.

Unfortunately, it's the same in the US for many insurances and it's really frustrating. My primary is great, but it seems like a wasted visit to go to him just so he can send over a referral to another doctor. It's just another one of the inefficiencies that inflate the cost of healthcare.

For a specialist. Patients often think they need a specialist or have no idea what kind of specialist they need so using a GP is better.

Many times patients who need a specialist know exactly what sort of specialist they need. If I hurt my knee, I can almost assure you I need an ortho or sports medicine doctor. Also when scheduling with a specialist the scheduler typically asks you a series of questions to determine if you're in the right place or not (this is a large part of my job).

 

[Danoff]

Seems to me you and @Sander 001 are both right (or wrong) depending on what province you live in.

It seems that isn't the case all across Canada and that there are differences depending on where you are. Given that it isn't the case all across Canada and that there other countries (e.g. UK, Australia) where a private health sector works perfectly well alongside the national sector I don't think your implication that illegality of private healthcare is an automatic given when universal healthcare exists is accurate.

It's in Canada then. There are provinces that are more open to it than others.

It looks likes Saskatchewan is the best bet for the most private services. But I know little of the demographics there.

Edit:

Ah, here:

Unfortunately, it's the same in the US for many insurances and it's really frustrating. My primary is great, but it seems like a wasted visit to go to him just so he can send over a referral to another doctor. It's just another one of the inefficiencies that inflate the cost of healthcare.

At least you can get around it, either by buying different insurance (PPO instead of HMO most likely), or by paying directly.

 

[Sander 001]

@Danoff

Only testing in Ontario?

Your link is 100% wrong and you should quit relying on sketchy websites.

"Rand Paul is scheduled to have surgery next week at the Shouldice Hernia Hospital in Thornhill, Ontario.
Paul has been an outspoken opponent of universal health care. But his office said Monday that critics attacking the senator for seeking medical care in a country with such a system were out of line, noting that the hospital where the surgery will be performed is privately run."




https://www.washingtonpost.com/poli...02f5f8-1828-11e9-88fe-f9f77a3bcb6c_story.html

 

[Danoff]

Only testing in Ontario?

"and procedures"

See

"New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary"

Ontario is a big part of Canada. Apparently Quebec is the "best" option, even though it has (apparently) a ban on private insurance. That's not a very good "best" option.


Edit:

And just btw, Rand Paul is not "insured" by the Canadian system, so most of their regulations don't apply to him.

 

[Sander 001]

Unfortunately, it's the same in the US for many insurances and it's really frustrating. My primary is great, but it seems like a wasted visit to go to him just so he can send over a referral to another doctor. It's just another one of the inefficiencies that inflate the cost of healthcare.



Many times patients who need a specialist know exactly what sort of specialist they need. If I hurt my knee, I can almost assure you I need an ortho or sports medicine doctor. Also when scheduling with a specialist the scheduler typically asks you a series of questions to determine if you're in the right place or not (this is a large part of my job).

And many times the patient has no idea but insists they do, wasting everybody's time.

Wait a minute, a scheduler is making a medical determination? Jesus Christ

 

[Sander 001]

"and procedures"

See

"New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary"

Ontario is a big part of Canada. Apparently Quebec is the "best" option, even though it has (apparently) a ban on private insurance. That's not a very good "best" option.


Edit:

And just btw, Rand Paul is not "insured" by the Canadian system, so most of their regulations don't apply to him.

So you're saying that this private hospital in Ontario is for people who aren't insured?

Btw there are 185 private clinics in Toronto that anybody can choose if they're willing to pay.

https://www.findprivateclinics.ca/Ontario/Toronto/lc-9-132.html

 

[Joey D]

And many times the patient has no idea but insists they do, wasting everybody's time.

Wait a minute, a scheduler is making a medical determination? Jesus Christ

No? Where did you get they make a medical diagnosis? They ask questions to make sure you're in the right place. For example do you have x symptoms? Have you had therapy? Have you ever been diagnosed with x?

Based on the answers the scheduler is told that the patient should see Dr. Jones for a 45 minute appointment. Schedulers make no medical diagnosis.

 

[Danoff]

So you're saying that this private hospital in Ontario is for people who aren't insured?

Btw there are 185 private clinics in Toronto that anybody can choose if they're willing to pay.

https://www.findprivateclinics.ca/Ontario/Toronto/lc-9-132.html

For procedures that "aren't medically necessary". See?

"New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary"

 

[Sander 001]

For procedures that "aren't medically necessary". See?

"New Brunswick and Newfoundland have few or no private clinics and, in Ontario, private health-care providers offer only tests and procedures that aren't considered medically necessary"

Your link takes you to
PREVENTION & RECOVERY
CANCER SCREENING: 4 CANCER TESTS YOU NEED TO KNOW ABOUT

Click on Ontario and I get 404 error

No? Where did you get they make a medical diagnosis? They ask questions to make sure you're in the right place. For example do you have x symptoms? Have you had therapy? Have you ever been diagnosed with x?

Based on the answers the scheduler is told that the patient should see Dr. Jones for a 45 minute appointment. Schedulers make no medical diagnosis.

I didn't say diagnosis, you said determine.

 

[Danoff]

Your link takes you to
PREVENTION & RECOVERY
CANCER SCREENING: 4 CANCER TESTS YOU NEED TO KNOW ABOUT

Click on Ontario and I get 404 error

I think that link was an ad. Not sure. It copy-pasted from the article. Yea it looks like it was an ad that I ended up carrying through copy-paste.

 

[Joey D]

I didn't say diagnosis, you said determine.

Ya, determine if the patient is in the right place or not. Not a medical determination, which is a form of diagnosing the patient. Say you hurt your shoulder while golfing and you call the ortho office. They'd ask you things like "where is your pain located?" and "did this pain occur as the result of an injury?" Based on the answers, it allows the scheduler to get the patient to the right doctor who sees that sort of condition or specializes in that area of the body. It makes things more efficient and manages to catch those patients who might not have the slightest clue what they're coming in for. However, based on all the reporting I do, the number of patients who just don't know is fairly low across the board.

 

[Danoff]

That's why I find it hard to imagine that universal health care goes "hand in hand with criminalizing alternatives".

I'm interested to know if people in the UK are complaining about rich people skipping the line the way they're concerned in Canada. Because that's the point with preventing alternatives.

And on that note, I'm interested to hear how nations with universal healthcare options (such as the UK and Australia) handle transgender treatments. If you can prove up the need for it does it get covered by public money? Or is it considered cosmetic? I'm guessing it's somewhere in between.

 

[TenEightyOne]

I'm interested to know if people in the UK are complaining about rich people skipping the line the way they're concerned in Canada. Because that's the point with preventing alternatives.

It seems generally accepted that if people "go private" then that's their concern. It's to the benefit of the NHS if people pay for their own treatments. You can also pay the NHS to undertake elective treatments, if you so wish.

And on that note, I'm interested to hear how nations with universal healthcare options (such as the UK and Australia) handle transgender treatments. If you can prove up the need for it does it get covered by public money? Or is it considered cosmetic? I'm guessing it's somewhere in between.

As above, some elective treatments (e.g. non-necessary treatments) can be bought from the NHS. Gender assignation surgery and the mandatory mental health therapy that goes with it (at least according to when I last knew somebody who received care in that regard) are available on the NHS but there are a serious of critical steps before any physical intervention.

 

[Tired Tyres]

I'm interested to know if people in the UK are complaining about rich people skipping the line the way they're concerned in Canada. Because that's the point with preventing alternatives.

And on that note, I'm interested to hear how nations with universal healthcare options (such as the UK and Australia) handle transgender treatments. If you can prove up the need for it does it get covered by public money? Or is it considered cosmetic? I'm guessing it's somewhere in between.

Not really. Anyone can jump if they want. The general view is make the NHS better so they don't have to. Don't underestimate how much the British people love the idea of the NHS mate.