Why can't the United States of America boast the same health structure as Canada?

Because in the USA, corporate executives own the politicians and control the government. And giving universal health care to the proletariat isn’t cost effective. It’s cheaper to lay them off in hard times and let them die if they don’t have the means to pay for medical care on their own.

Doesn’t Canada have a much higher tax rate and/or cost for things? (Like why does a book or magazine have a significant difference in cost difference displayed for the Canadian price?

I’m just throwing an idea out here. I don’t know much about Canada’s systems.

And @HungryGuy is right. . . unless we start getting leadership that isn’t part of the status quo, no changes will be made to benefit US!

People don’t want to pay higher taxes for themselves and others. Some people only see taxes as them paying for poor lazy people, and since those are the only people they seem to have a problem with, they see them as destroying America because without all the poor sick lazy people, America would be so prosperous.

There still is a debate as to which is really better. What is the advantage if the care is free but the wait is too long to receive it? In both countries there is only just so much help to go around. The longer the line, the longer the wait. Here in the US it is almost a sin for a doc to have any kind of bedside manor. It just isn’t practical to do one on one care, and even hope to see everyone in a waiting room. When was the last time any of us saw a doc on a schedule and not be way behind?

@woodcutter I am LUCKY to have found a physician who sees me when I’m scheduled to be seen. But I know what you mean, b/c I’ve experienced it in the past, and have friends who still complain about it.

It seems standard to make someone wait 30–40 minutes past their scheduled appointment. In fact, I think my doctor is weird for not putting me through it. LOL

I never have to wait more than a few minutes to see my Dr. at the appointment time.
I never have to wait weeks or months to get an appointment with a Dr. or even a specialist. If I think I might have the flu, I can get in to see my Dr. or a Physician’s assistant tomorrow. Tomorrow.

I have friends in Canada who have waited weeks for a breast lump biopsy. It was agony for them. They have waited months to see a specialist. They complain all the time about how long it takes to get care and are astonished at the service that I can get, and usually without too long a wait time.
Certainly the the American system is faulty, and needs to be improved, but I’m not sure that the Canadian model is all that perfect.
I think that there must be a better way out there, and I hope that we find it very soon.

Canada’s health care system sucks. Many a Canadian have confirmed it with me.

@digitalimpression, I don’t know. I have three people I’ve talked to about it, including one MS patient, and they all three love it. The only thing that they point out is that here we are so caught up in “fixing” everything, and sometimes the best alternative is to focus instead of making it possible to live with it. Here in the US we seem to be focused instead on “getting rid of something” forever.

@woodcutter – What is the advantage if the care is free but the wait is too long to receive it?: how long is too long? Accessibility is what matters. If one cannot pay for one’s care in the US, I understand, well tough. I have no doubt that Canadians complain about the quality of their health care. I wonder what they would say to a Brazilian state-funded clinic, or to the National Radiotherapy Centre in Trinidad and Tobago? When I go to clinic, I take care to carry a book to read and a bottle of water. Depending upon location, I may have to walk with my own toilet paper. Believe me when I say that a reasonable chance of getting professional care outweighs the irritations of delays and shortages.

@digitalimpression I’m grateful for it. I think that it’s wonderful.

@mrrich724 The differences you see in prices on book and magazine cover prices are due to fluctuations in the values of our respective dollars, not to taxes. There is, naturally, a long lag between the time when you observe a change in the value of the dollar and the time when you observe the cover prices, since the price is set when a contract is signed… then it takes time to print the cover, and then that cover can sit around a while before you see it.

@digitalimpression I am a Canadian, and my healthcare system does not suck, thankyouverymuch. Now you can tell people that you’ve heard Canadians confirm that it works.

@others, regarding wait times, I have never opted not to see a doctor because I feared the wait time… can Americans say the same about their bills? I would guess the wait in my GP’s office is about the same as my dentist’s office (and dentists are not covered). Mileage varies pretty widely (can be very fast or very slow) when it comes to specific procedures. I don’t know whether that’s because of the region or the procedure or what. But to Americans – do you never have to wait for a medical procedure in your country? I often hear this as a criticism of our system, but seldom what it’s being compared to.

@dappled_leaves I was also referring to having to wait so long to see a Dr. after an appointment is made, sometimes months there, and usually not that way here.
Yes I do know people, myself included who have put off medical care because I couldn’t afford it. It’s not good for a lot of people. As I said, some of what we have certainly needs to be changed, improved and much more inclusive. I’m just not sure that the Canadian model is the right one for our country.

Fair point. I’m not as familiar with healthcare in countries other than ours.

Good Lord eh.

Well some of your fellow Canadians very strongly disagree with you.

There are more people in California than in Canada for one thing.

The US system is optimized for one variable: the profit for health insurance companies. Primary care docs make so little on doing rounds on their hospitalized patients, that the only people to see them now are hospitalists. So if you have a long and complex medical history that’s being managed by your GP, the people overseeing your care will often know next-to-nothing about it, and if you have many hospitalists working a floor for an extended period of time than it’s very easy to fall through the cracks.

I watched my grandmother suffer tremendously and unnessecarily in the last couple of weeks of her life because of the way our system has evolved. She had Medicare, and long term care.

Health insurance companies are essentially leeches on our healthcare system that suck out the dollars that could be going to patient care. We spend nearly double per person what Canada does, just think how much better Canada’s system would be with twice the funding. I think that would be a much better comparison. I would gladly pay more in taxes and nothing in insurance premiums, especially knowing that if I truly got an expensive sickness, that my insurer would hire someone to comb through my application and medical records with a fine-tooth comb to find a time when I neglected to mention a MD appointment 15 years ago for the Flu, use it as an unreported preexisting condition, and drop my policy, leaving me to die, my MD and the hospital to not get paid, and the health insurer to write themselves a nice bonus check with the money I’ve been paying them my whole life.

@fredTOG Hmm, never took that into consideration. Does Canada’s style of healthcare system then only work for about 34,000,000. I’m wondering now if perhaps out of 34,000,000 more people are educated and etc as opposed to the roughly 310,000,000 that live in the U.S.A. I’m guessing it must be easier to manage 34,000,000. Anyone got stats that prove the healthcare system exists solely due to it’s number of citizens? Or does it not matter.

I remember staying at a hotel years ago, and I was in the hot tub with other hotel guests, and two were Canadians, talking about how great their health care system was.
Eventually they mentioned they were in town to have some tests done. Seems Canada didn’t have the expensive equipment they needed for this test.

Guys, I didn’t necessarily mean long waiting room visits as much as I meant those long waits to see a specialist like weeks or months north of the border. It can be hard to decide which would be worse: no insurance thus limited access, or govt run health care and be made to wait a long time possibly adding to the severity of the health problem. There is suck with both systems.

Because hard right wing folks think its Socialism. Gasp!

I am unfamiliar with the Canadian health care, but I’ve had Italian care, which is (I gather) similar in its administration.
It was nice to be able to make an appointment to see the doctor and swing past the pharmacy on your way home and not front a single Europenny. The hospital waiting room line was short – I saw someone go from massive gash to clean stitches within about 30 minutes of the initial accident.

But if you wanted a specialist, you had to either wait or pay out of pocket; some of those lines were months long, and if you needed the eye doctor sooner, well, SOL and maybe try squinting. I knew two people who were allowed to die of their cancers because they came out of remission. The hospitals did little to accommodate a long stay – silverware and toilet paper were DIY. The hardware was well behind the state-of-the-art stuff that you see here.

@bea2345 Long waits =/= accessibility
@GracieT There’s nothing wrong with wanting to eradicate a problem. Doctors aspire to heal, not just suppress symptoms with sundry medications. In Canada, they control.

@filmfann, @woodcutter, @Nullo do you think the wait times would still be as long if their governments were spending the same amount per person? You could pay a lot more specialists with double the entire healthcare budget.

@gorillapaws if I may jump in here, my Canadian friends are upset because according to them, “all the specialists and good Drs. go to the U.S. to practice medicine because they can make a lot more money there”.

The US has the best doctors and facilities in the world… The problem is that thanks to a system that is predicated on making money, not everyone has access.

There are certain things that shouldn’t be left to the hands of for-profit private industry, because our companies here in the US are the best in the world at doing what they’re meant to do… unfortunately they’re meant to make money, and actually providing the service they’re tasked with providing comes second to share holders.

@wilma right, but if there was twice as much money in the Canadian system to pay MD’s better and buy better equipment etc, would that still be true? Shouldn’t we be comparing a system funded to the same degree as the US is?

It’s like saying that Mercedes is faster than that Chevy Malibu, therefore the German car manufacturing process is superior to the American car manufacturing process. Shouldn’t we be comparing a Corvette to a Mercedes and then decide which systems works the best? The opponents of universal healthcare are stacking the deck before making the comparison.

Yes @gorillapaws more money in the system (from more payees) would probably help. Although I don’t think that that is the only issue.

I’m not going to argue for or against the Canadian system since everyone has their own opinions, however the system as it is today wouldn’t support this many people and the cost of such a system would be so incredibly high unless cost reform occurred in this industry. For example the average cost of HIV drugs in the US per year is about $8000 (average). There are about 1.1 million people with the disease. This is about $8.8 billion a year for HIV drugs. This is one disease albeit expensive disease, but one of many. The other issue many people are concerned with is the fact that many people don’t actively pursue better and healthier lifestyles in the US. Many Americans smoke, eat way too much, drink way too much, don’t exercise, take unnecessary drugs, and are involved in just generally unhealthy lifestyles. It then comes down to do we as American citizens have the right to healthcare even if we ourselves don’t actively participate in healthy life styles. Should all American’s be forced to support treating lung cancer patients who have made the decision to smoke their whole lives? Some people will argue people have this right some will argue the opposite.

Of course you have the other end of the spectrum. Do people who live healthy lifestyles and are simply just unfortunate enough to get cancer deserve the right to healthcare. Some people again would argue they have this right and some would argue they don’t.

But even if we determine that we have this right, the current cost structure won’t work. Secondly a lot of people argue that the government should not be a middleman but rather reform the industry through federal requirements and allow capitalism to flush through the issues to make it an efficient system.

@critter1982 your analysis of the HIV drugs is horribly oversimplified. With hundreds of thousands more HIV patients getting treatment, and their cost to produce each additional unit being very small, you could expect the price of the drug per unit to decrease while the overall profits to only increase a little bit. In other words, the more people you treat for HIV, the cheaper it becomes to treat each one.

The drug industry has a lot in common with the software industry: to sell 1 dose of a drug could be $100 million or more, but to sell 2 does the price only increases by something negligible like a few dollars—once you have the R&D, testing/human trials, and manufacturing costs recouped, there is very little additional expense. The massive increase in the number of users and the ease of accessibility of 3rd party software on iPhones/iPads/Android etc. has caused the prices to plummet.

Given this, it makes no sense to do a linear multiplication of the number of additional HIV patients by the current cost of the drug. This principle would apply to many other areas as well.

@gorillapaws: Absolutely prices could go down with more customers. However most companies aren’t going to decrease their bottom line or even their margins if they get more patients. More patients will decrease the price/capita but in the end more patients will be a larger burden to the amount of money required for any particular drug.

I also agree that a lot of companies if not all companies roll their overhead costs, costs to develop the product and prototype it, and the capital to tool the product into the price for so many years. In the end this partially drives the standard price reductions over so many years of the product that we always see. One problem you didn’t mention however is that just like the software and hardware industry they get patents on these drugs which last for 20 years. With no competition to drive decreasing prices theirs no reason to lower prices since these companies remain loyal to their investors and more money is always a good thing to them. Also unlike the software and hardware industry people are less likely to try a cheap China rip-off of what they may call the same product.

So even though my basic mathematicall skills used some very large and generous assumptions it still makes some sense in terms of the first 20 years of these drugs. Especially since tons of R&D is still going into developing new drugs. Large cost/price reductions will not occur on HIV drugs for a very long time.

@critter1982 you’re ignoring the power of collective bargaining. With more people the government can negotiate a better price. I’m pretty sure insurance companies use this all of the time. They certainly do it with MD’s, which is why it can be hard to stay in practice as a single MD with little bargaining power.

@gorillapaws: I’m not ignoring collective bargaining. I agreed that the price/capita would go down because of larger demand. What I’m saying is that these companies aren’t going to decrease their bottom line though, or potentially even their margins if they don’t have to, and they don’t have to if their isn’t any good competition Collective bargaining only works if you have competition. When bargaining for things like cholesterol drugs where there are tons of competitive drugs in the market I absolutely agree with you, but not for diseases out there that are not fully understood or capable of being controlled by any specific drug. If anything the price/capita goes down but overall system cost goes up because of the increase in consumption. The only way the 8.8 billion number goes down is if companies sacrifice on their margins and to do that there needs to be good competition.

@critter1982 that may be true about competition, but remember that we’re talking about competition between drug companies and competing drugs, not between government/insurance companies vs. a single manufacturer of a patented drug. Are you suggesting eliminating/altering the way drug patents work?

Your analysis is also ignoring the savings by cutting out health insurance which add $0 of value to the system, but siphon out quite a bit for themselves. Much like a parasites, they do nothing to contribute to the healthcare system. If you take the total premiums paid to the health insurance industry, and subtract out the total benefits paid out on all claims, the difference is the extra cash that will be infused into the current system that is currently doing nothing to help patient care.

@gorillapaws: Yep I am talking about competing drug companies. Without this competition, the government does not have any grounds to stand on to push drug profits down. I’m not suggesting eliminating/changing standard operating procedures for the patent office at all. Companies need some time to reimburse themselves for the years of R&D and failed R&D.

I don’t disagree that I discounted the savings by cutting out health insurance companies but if you look some publicly available data on Google Finance, you’ll see that some of the larger insurance companies make less than $100/year per enrollee which doesn’t have that much impact on my example. For example Aetna in 2009 made $30,950,700,000. EBIT equated to $2,174,200,000. Profits after taxes equated to $1,384,100,000. Their enrollment that year was 16,318,625. If you divide this out per enrollment you get $84 of profit per person over a year. I would suggest that alternatively going to a government run program wouldn’t be that much better, if any, as there is no drive to flush out inefficiencies when you have no competition and no bottom line. For example the current Obama health care plan will take $500 billion away from Medicare over the next 10 years and as explained to us by our legislators, actually improves the Medicares standing, which means the whole system was really inefficient.

The health insurance industry is not the main driver for high medical costs, sure it’s an adder but not significant enough to reduce the huge costs of health care. In fact in comparison to other companies their profit margins are around 3% which is in line with the food industry which has some of the lowest margins of any industry. For sake of comparison the software industry tries to sit between 20 and 30% profit margins. Many, many other changes need to occur to make the system work, hence my original statement, Canadian healthcare won’t work here without changing the overall cost structure of the industry.

@critter1982 I’m not talking about profits. I’m talking about the total difference between what they take in and what they put out, this would include a lot of things that don’t fall into the profit category such as the $102 million dollar bonus that United Healthcare paid to it’s CEO, Stephen Hemsley in 2010 alone. Figures like that aren’t reflected in profit at all.

I went to the emergency room got 2 X rays $ 1,000 that’s all they did, why so much, greed .

@fredTOG Part of that is because the hospitals are trying to offset the cost of people who do not pay their hospital bills. Hospitals are required to treat everybody, and they have limited recourse in collecting their due.
Keep in mind that hospitals have their own bills. They have utilities to buy, food, medicine and bandages to keep in stock, and all of those little devices to keep current (after all, nobody wants to go to a hospital powered by old technology). And then there’s insurance – building, liability, malpractice, you name it. There are doctors and nurses and janitors and launderers to pay, and if you want talent, it’s going to cost you more. When someone skips out, someone else has to pick up the slack.

@woodcutter – That’s simply not a true criticism: “What is the advantage if the care is free but the wait is too long to receive it?” I can’t say about Canada, but in the UK the wait for a doctor appointment is no worse than in the USA (it depends more on the particular doctor than the “system” of either country). And waiting to see a doctor during an emergency room visit is worse in the USA than in the UK (at least in urban hospitals in NY and NJ).

@gorillaPaws This 102 million dollar compensation is about .004% of what the US spends on health care. This in and of itself is not going to reduce costs.

@HungryGuy I was referring to a specialist in a field that usually work on treating patients for some dire shit. There will always be more sick and hurt people than there are docs to go around. Here in the States ,there are times when the uninsured will get a better deal than a person who is insured to the hilt. Not always but often. Policy holders and their insurer’s are always getting screwed why, because they can be. People are put through many unnecessary tests and procedures because they are branded as deep pockets. It is a big part of the reason why health care is so high.
Take someone like me. They aren’t going to do the bells and whistles with me. They are going to cut to the chase and skip a lot of that fluff medicine. So far, knocks on wood, they have done well by me. It is in the medical field’s best interest to go whole hog on every little thing they can because like what has been mentioned… they gotta make more money. There are too many cessarian sections being done, talking about the times when the baby would have worked its way out just like old times. An assload of money will be generated with C-sections than with vaginal deliveries.

I don’t know if Canada has the same deals where there are docs receiving kickbacks from pharmaceutical Co’s for pushing certain drugs over others. They’re only human so if the good one’s are packing up and working in the States to get a more respectable salary it would make sense they are also involved in the practice. Just a speculation…but I’m usually right. It’s creepy to imagine this, and it becomes one teeny positive aspect of being a G.O.M.E.R. They aren’t even going to consider getting me on these high dollar cutting edge meds. They know I can’t afford them so, they prescribe some generic shit that does the job fine. I’m just no fun for these guys.

@critter1982 you’re completely missing (ignoring?) my point. That was one dude’s salary at only one insurance company that makes up for a significant chunk of the entire budget. How many people’s treatment had to be delayed or rejected, or doctors’ reimbursements had to be withheld to generate that much money—and it’s only one guy? Furthermore it is just one example of the kinds of things that won’t show up in the profit metric you’re using. Subtract out the operating costs, the marketing costs, the political slush fund costs, the contributions to media campaigns to trick people into thinking that Heath Insurance Companies are good for you, or the salaries of all of the post claim underwriters such as Lee Einer.

If you total all of that up for all of the insurance companies, you’re looking at a significant chunk of the budget. That’s why the appropriate metric is money received via policies minus money paid out in claims. The difference is much closer to the amount that would be saved by axing health insurance from the equation than just looking at profit (which any savvy investor can tell you is a very fuzzy construct when looking at a corporate balance sheet).

Because Canada and the US are actually different countries (gasp!) with different values and interests. British Canada is a group of people who honored and obeyed King George instead of throwing tea in the bay. They did not fight for their independence. They did not win their west through bands of roving outlaws, but rather by tidily dressed mounties riding on horseback. All very civilized.
By and large, they do what they are told and BELIEVE in their government. In the US there is a deep seated DISTRUST of government and a general belief that a free market is better in virtually all situations, even when run by corporate gangsters who bribe public officials

@gorillapaws: I’m not ignoring your point, it’s just not as bad as you are representing it to be and it comes no where close to closing the gap that we have. Reference this expenditure per capita cost sheet and you’ll see that the “net cost of private health insurance”, which includes all of the money absorbed by health insurance companies, rather than paid out to various types of health care runs between 11%-13% of total insurance premiums. A 12% OpEx is good by anyones standards. I couldn’t find Medicares OpEx but I would be surprised if it sat less than 12%, even though they do force some of their providers to do their admin for them.

The main problem with health care spending is, as even Obama has said repeatedly, that it costs more to provide care in America than elsewhere (mainly because our medical professionals make more and we have more expensive equipment) and people get more total care, but we don’t in aggragate end up much healthier as a result. The whole point of government health care is to make sure that people get less care but end up at least as healthy as before, thus creating savings, and then use those savings to provide care to the small percentage of the population who are currently not getting care or not getting if efficiently.

@woodcutter – Specialists. Right. They’re always hard to see straight away in any system. I see your point about doctors milking the system to get more money out of people with insurance. Methinks lawyers are also involved. Liability, you know, if you don’t run every conceivable test :-/

Ideology and ignorance, mainly not understanding the difference between solidarity and socialism.

@critter1982 but the ultimate point here is that they don’t help sick people get better, they are middlemen that add a huge amount of expensive bureaucracy and unnessesary complication to the system. Every minute a MD has to sit there on the phone trying to explain to an idiot at a health insurance company who knows nothing about medicine why a certain procedure is necessary for the patient is time they are not spending making sick people healthy.

They literally contribute nothing to the process, and create a lot of friction and complication. I hope you personally never have to experience the horrors that can result. As a fan of efficiency, cutting out the insurances would be the simplest way to purge waste from the system.

I also agree with others about defensive medicne driving up costs. I think it’s less about MD’s trying to get rich and a hell of a lot more about not wanting to sit in front of a jury and explain why they didn’t order test x that had a chance of detecting the thing that killed the plantiff’s little girl.

@gorillapaws No matter how the system shapes itself you are always going to have a middleman. Whether that middle man is private for profit insurance companies, non-profit insurance companies, or government. No matter what there will be overhead costs and money put into that system that won’t go directly to caring for somebodies health.

I think we are on the same page because I’m not disagreeing that we should try to minimize these overhead costs as much as possible to make healthcare more affordable to everyone, however our likely point of discontention is how we get there. Your belief is that for profit insurance companies drive too much wasted cost into the system because they provide nothing of benefit other than being a monetary middleman. My argument would be that throwing government into the mix convolutes the parties involved even more since much of what we call Medicare now which is government subsidized healthcare is managed by private contractors anyways. Throwing government into the mix would likely only increase overhead costs, so rather than including government how about we make healthcare tax free, drive for tort reform which I have heard is driving about 20% of healthcare costs, and allow health care companies to compete all over the US?

@Nullo – Long waits =/= accessibility It took me a while to find out what the symbol meant and very descriptive it is. When the choice is between a long wait and no care at all, then the formula is wrong. It is true that some waits are too long. For instance, I was referred last December to Port of Spain General Hospital for a mammogram and a CT scan. The earliest appointment I could get was 20 April 2012. Upon consideration, I decided that my condition (breast cancer) called for something earlier, so I dipped into my savings and had it done privately last week. (I am happy to say my condition is improving). I am one of those that have the option of paying if I have to. But there are people in my country – the majority – who would have to take their chances and hope that their disease did not worsen while waiting for an echocardiogram or an MRI, or to see an ophthalmic surgeon.. The chief drawback of the U.S. system – and I have had some slight experience – is that payment is absolutely necessary, even in emergencies. There seems to be little provision for preventive medicine – free ante- and post-natal care, free well baby clinics up to the child’s fifth year at least, vaccination at the state’s expense and so on. Of course, mine is a relatively poor country, a third world country with all that that term implies. Without the state services, our health indicators would be similar to those of Chad.. Yours, on the other hand, is a a still wealthy country with a well-fed population. Up to now the free market has provided most of your health services. Maybe it is time to think of other options.

@critter1982 “Throwing government into the mix would likely only increase overhead costs” That’s a very substantial unsupported premise. There are lots of expenses that the government wouldn’t have that private ones do (I listed them above such as executive bonuses, marketing, etc…).

Additionally, insurance companies create a lot of wasted effort in the system. They play games where the MD’s office will bill for X, and they’ll short the office to see if it gets picked up, if someone catches the error, then a new request is filed, they stall etc. Also they play similar games with getting approvals, and keep staff on hold for excessive periods of time. They play games with referrals, they play games with how procedures get coded. Essentially they try to complicate the process as much as possible in the hopes that balls get dropped and they don’t have to pay.

In the small surgical practice that I work in with a MD and a PA as the only 2 providers, we have a team of 3 people submitting bills, and dealing with insurance approvals. You can’t tell me that’s not adding a lot to the total cost of healthcare.