Analyzing Health Care


I think not
#1
My primary objective in this analysis is not to deride the good work done by those on all sides of this issue. Instead it's to show that while looking at Canadian and American comparisons is valuable, it's not OK to look on the surface and ignore the many complexities underneath that surface. Worse it's totally dishonest to take "facts" out of context or tell blatant lies.
Health systems everywhere are under financial strain--always have been and always will be. Canada certainly limits access to high technology and specialists by limiting investment in them upstream. The US does not, but citizens living in Canada are very unlikely to run into severe financial trouble because of their health--not so in the US. For those of you who will read this thread, please take under consideration that I am not part of the Canadian Health Care system and therefore I can only compile information based on research and not from personal experience. In addition I will offer information on how weaknesses of the US health care are sometimes skewed, but I will leave the critique by members of this board, I will only offer facts. So lets look first what I have compiled to be strengths and weaknesses in each system and we will run an in depth analysis of each:

THE CANADIAN HEALTH CARE SYSTEM

The Canadian health care system expresses the fundamental equality of Canadian citizens. The plan's coverage is comprehensive, universal, and accessible. Known as a "single payer" system, funding for medically necessary care is provided by the provincial governments through taxes (with guidance and some funds from the federal government). Patients are free to choose among providers, and physicians serve primarily in private practice on a fee-for-service basis. Hospitals are independent, nonprofit institutions overseen by boards of trustees.

Canada's health care system began as a grass roots action in Saskatchewan in the late '50s; by 1966 all provinces offered such plans.

The Plan's Strengths:

• All citizens have access to care; no one may be denied services on the basis of income, age, or health status.
• Benefits are the same for all citizens.
• The plan relies extensively on primary care physicians; 63 percent of all active physicians in Canada are in primary care.
• Canada achieves substantial administrative cost savings, since providers and insurers do not need to market themselves or employ vast staffs to process paperwork. Physicians bill the provinces directly and avoid the expense of verifying coverage, seeking approval to provide services, completing paperwork for multiple private insurers, or coping with double-billing and uninsured patients.
• Under a single payer, the provincial governments are able to set and enforce overall budgetary limits. Physician fee schedules are negotiated with the local medical associations and are binding; no additional billing is permitted.

The Plan's Weaknesses:

• Financing of Canada's health plan has been generous during periods of growth and tight when government must control its deficits.
• Access to some high-tech procedures has been limited by a shortage of equipment and hospital beds.
• Benefits are basic - only procedures deemed "medically necessary," are covered (e.g. optometrists and dentists may not be covered.)
• Cost over-runs - primarily in physician services - prompt provincial governments to increase cost controls, resulting in outcries of "rationing" by providers and, on several occasions, political uproars.
• Private insurance for covered care is not permitted because this would defeat the purpose of spreading the risk over the entire population. However, insurance is allowed to fill available niches, such as for dentistry, pharmaceutical drugs, and certain hospital services (i.e., private room charges).
• Long wait times for basic surgical procedures.
• In Canada, prescription costs are not generally covered except for those with low incomes. Private, employer insurance plans, or individual supplemental plans, usually cover prescriptions, with some deductibles and co-payments.

THE US HEALTH CARE SYSTEM

America does not have a "system" of health care as much as a tradition of laissez-faire practices that have developed over time. The central element is a financial arrangement that pays for health care services through employer-purchased insurance. Historically, patients have had the right to choose any physician, and physicians have been free to choose among specialties and to practice where and how they like.There are now more than 1200 private insurance companies in the US.

For some of the uninsured, the government pays for health care through Medicaid, the military, Native Americans, the Veterans Administration, and other state programs.

The System's Strengths:

• High-quality services are available for those with insurance.
• The US is at the forefront of clinical research.
• Major technological breakthroughs have occurred in treating numerous diseases.
• There are large numbers of physicians, especially specialists.
• Elderly Americans over the age of 65 are all covered under a universal program called Medicare

The System's Weaknesses:.

• 45 million Americans (17%), have no health insurance or coverage (the highest in the industrialized world).
• The cost of health care in the US is the highest per person in the industrialized world and growing the fastest.
• Administrative overhead is high - 19 to 24 percent of all health care costs, versus 11 percent in Canada.

There are so many issues to bring up it is vitually impossible to list them all, however this is a good start I found and what I have seen to be a very pressing issue on both sides of the border. I will first begin an analysis of the weaknesses of US Health Care. The first analysis I will be addressing is the uninsured Americans, I should have all the data compiled by tomorrow and begin that part of the debate. For those of you interested, take the time to think about the pros and cons of each system and by all means share your opinions.

Thanks and lets begin

P.S. Thanks to Vanni and Bluealberta I have spent dozens of hours reading the Romanow Report, Health Care Studies and statistics from various organizations on both sides of the border. So you two better take part in this :P
 
bluealberta
#2
I Think Not:

Thank you for your first "installment" on this topic. I think you have summarized things very well. In your analysis, I think that one of the really important things to determine is the cost to the consumer, or individual if you will, at the end of the day for comparable services. I don't know if this is possible, so would it be possible to provide some sort of net cost for comparable individuals in each country.

For example, for a Canadian earning $50k per year and a US citizen earning $40k per year (basically same income after exchange calculation), what is the cost of health coverage for a family of four, for example, after taking into consideration different federal tax rates (forget state/provincial taxes, they are too variable for this discussion), and items such as mortgage interest deductions. What part of the annual premium in the US is paid for by the employer and what part is paid for by the employee.

I don't know how deep you can or want to go, considering co-payments, deductibles, etc., but if you have any comparison as noted above that may give a reasonable idea of the differences or similarities between the systems.

Thanks again, I have been looking forward very much to your thread, and will continue to follow it closely.
 
I think not
#3
The average cost of health insurance for a family of four in the US is now (2005) $10,000. That's up 60 percent over the past three years – since 2002. Of that total, employers paid $7,289 and employees paid $2,661.

The $2,661 is deducted from the gross salary (before taxes). This in essence means that the federal government (by way of tax breaks) picks up 35% of the employees costs. In reality the $2,661 is really $1,729 annually.

Keep in mind these are national averages, in certain regions of the US (Northeast), they are higher and other regions (Southwest) lower.

Here's a sample of all four corners of the US:

Maine
Employee Contribution 29.1%
Employer Contribution 70.9%
Total Premium 100.0%

Florida
Employee Contribution 24.9%
Employer Contribution 75.1%
Total Premium 100.0%

California
Employee Contribution 23.8%
Employer Contribution 76.2%
Total Premium 100.0%

Washington
Employee Contribution 18.8%
Employer Contribution 81.2%
Total Premium 100.0%

For details on this data you may reference this website:

State Health Facts (external - login to view)
 
Dexter Sinister
#4
Quote:

So lets look first what I have compiled...

What *you* have compiled?

www.context.org/ICLIB/IC39/CoopTalr.htm (external - login to view)

So, are you Ed Cooper or Liz Taylor?
 
I think not
#5
The information was derived from a number of resources, I will post links for your own information to review. That was the simplest form of list I can find to further the discussion. for all intensive purposes NONE of this information is mine. It's all from various organizations, Canadian as well as US. Better?
 
Dexter Sinister
#6
No, the information in the OP came from one source, you did a straight copy and paste on it, and claimed it as your own.

Just keepin' you honest.

And BTW, the phrase is "for all intents and purposes..."
 
I think not
#7
Keeping me honest? Why dont you have a closer look at that link and compare the lists. And I assume you do know what "compiles" means
 
bluealberta
#8
Quote: Originally Posted by I think not

Keeping me honest? Why dont you have a closer look at that link and compare the lists. And I assume you do know what "compiles" means

Keep going, 1. Don't let the naysayers detract you. Your figure of $2661 is what I also had obtained doing my research about 3-4 weeks ago, which I think got you going on this. (Sorry )

And since I live in Alberta and you live in New York, I would suggest that any accusations of collusion are false. Anyway, keep going, I really want to hear all your conclusions, etc.
 
I think not
#9
This is a sample mortgage breakdown I found off an accountants website, maybe this will help you blue. I'm not sure how that is relevant to health care, I'm sure Canada has the same tax deduction on mortgage interest.

Under the current tax code, mortgage interest on first and second homes is generally deductible as long as these loans total less than $1.1 million, making homeownership one of the best ways to trim your tax bill. The examples below illustrate how the mortgage income tax deduction affects the after-tax homeownership.

Homeowner Profile
Gross Income - $35,500
House Price/Mortgage Size - $115,000 - $23,000 down=$92,000
Loan Type - 30-year Fixed-Rate mortgage at 10%
Property Tax - 1.23% of home value ($1,415)
Filing Status - Files jointly/four exemptions

According to the tax code, this homeowner's deductions for mortgage interest and property taxes would be evaluated at a 15 percent marginal tax rate. Non-housing itemized deductions (i.e., state and local taxes, non-mortgage interest and so on) is estimated at $2,000 and the standard deduction is $5,450. Under the current tax system, the homeowner saves $1,071 because of the mortgage interest deduction. You can figure what your own costs and savings will be by substituting your own tax figures for those on the chart.

Example of the impact of the Mortgage Income Tax Deduction on Annual Homeownership Costs:

Before-Tax Homeownership Costs
Mortgage Interest=$9,177
Property Taxes=1,415
Total of Before-Tax Homeownership Costs=10,592

Itemized Deductions
Homeownership Deductions
Mortgage Interest=$9,177
Property Taxes=1,415
Non-homeownership Deductions=2,000
Total=12,592

Standard Deductions=5,450
Total Itemized Deductions=$7,142
Multiply Total Itemized Deductions by Marginal Tax Rate to get Homeownership Tax Savings: $7,142 x .15=$1,071

After Tax Homeownership Costs=Homeownership Tax - Before Tax Savings: $10,592 - 1,071=$9,521

Let me know what you need clarifying. And also I couldnt find any federal/provincial tax deductions for the Canadian Medicare system, I looked at Revenue Canada (best source I could think of), maybe you could shed some light.
 
bluealberta
#10
Quote: Originally Posted by I think not

This is a sample mortgage breakdown I found off an accountants website, maybe this will help you blue. I'm not sure how that is relevant to health care, I'm sure Canada has the same tax deduction on mortgage interest.

Under the current tax code, mortgage interest on first and second homes is generally deductible as long as these loans total less than $1.1 million, making homeownership one of the best ways to trim your tax bill. The examples below illustrate how the mortgage income tax deduction affects the after-tax homeownership.

Homeowner Profile
Gross Income - $35,500
House Price/Mortgage Size - $115,000 - $23,000 down=$92,000
Loan Type - 30-year Fixed-Rate mortgage at 10%
Property Tax - 1.23% of home value ($1,415)
Filing Status - Files jointly/four exemptions

According to the tax code, this homeowner's deductions for mortgage interest and property taxes would be evaluated at a 15 percent marginal tax rate. Non-housing itemized deductions (i.e., state and local taxes, non-mortgage interest and so on) is estimated at $2,000 and the standard deduction is $5,450. Under the current tax system, the homeowner saves $1,071 because of the mortgage interest deduction. You can figure what your own costs and savings will be by substituting your own tax figures for those on the chart.

Example of the impact of the Mortgage Income Tax Deduction on Annual Homeownership Costs:

Before-Tax Homeownership Costs
Mortgage Interest=$9,177
Property Taxes=1,415
Total of Before-Tax Homeownership Costs=10,592

Itemized Deductions
Homeownership Deductions
Mortgage Interest=$9,177
Property Taxes=1,415
Non-homeownership Deductions=2,000
Total=12,592

Standard Deductions=5,450
Total Itemized Deductions=$7,142
Multiply Total Itemized Deductions by Marginal Tax Rate to get Homeownership Tax Savings: $7,142 x .15=$1,071

After Tax Homeownership Costs=Homeownership Tax - Before Tax Savings: $10,592 - 1,071=$9,521

Let me know what you need clarifying. And also I couldnt find any federal/provincial tax deductions for the Canadian Medicare system, I looked at Revenue Canada (best source I could think of), maybe you could shed some light.

Thanks for the information, I will study it a bit. No, Canada does not have a mortgage interest deduction. I am not aware of any deductions for our health care system. REvenue Canada is now called Canada Revenue Agency.

I wanted to give you this little anecdote: Last Tuesday I had to take my wife to the hospital emergency ward because the Rev pushed her down the stairs (Just Kidding, Rev ). She did trip over the dog though, and twisted her foot/ankle bad enough we thought she may have broken something. Anyway, when we get the emerg ward, there is no one else there, so we think we should get looked at, diagnosed, and out of there quickly, right? Wrong. An hour and a half later, she finally gets an Xray, which revealed she had torn some ligaments in her foot. The emerg doctor said that a nurse would be in to put a tensor on it and left the room. Forty minutes later, I went looking for someone, because no one had come yet. Were the nurses busy? Not likely, since they all got together so sing a rousing rendition of Happy Birthday to someone over the phone while my wife was waiting. We saw the original doctor, who then came and put a tensor on her foot and after having her sit in a wheelchair for 40 minutes with her foot down, told her it was important to elevate her foot to speed recovery! Un-friggen-believable! Over two hours for an Xray and tensor. And others on here wonder why I have such a problem with our supposed model of good efficient health care.
 
I think not
#11
In all fairness blue, do you live in a rural area? Or is it urban? And perhaps the emergency room was full, if its full that can happen anywhere really.
 
I think not
#12
In all fairness blue, do you live in a rural area? Or is it urban? And perhaps the emergency room was full, if its full that can happen anywhere really.
And no mortgage interest deduction? Are mortgage rates typically low though?
 
bluealberta
#13
Quote: Originally Posted by I think not

In all fairness blue, do you live in a rural area? Or is it urban? And perhaps the emergency room was full, if its full that can happen anywhere really.

Sorry, I wanted to mention I live in an urban center with a regional hospital for our area. There were no people in the waiting room, and none in the exam rooms. While we were there, an elderly gentleman was brought in my ambulance.

I was also speaking to someone involved in our local health units, and he told me that a lot of people are now starting to call 9-11 for what could only be classified as non-emergency reasons. Why? Because they are given priority when they arrive at the emergency ward. Great little system we have here, this publicy funded everybody fits system.
 
Jay
#14
Quote: Originally Posted by I think not

In all fairness blue, do you live in a rural area? Or is it urban? And perhaps the emergency room was full, if its full that can happen anywhere really.


I'm not sure this is how the system was sold to us though. Were supposed to have the best health care in the world.
 
I think not
#15
There is no perfect system Jay. Even the French being #1 according to WHO, have their problems.

I've been to Greece and stayed there for a bit, WHO ranks them 14, Canada ranks 30th and the US ranks 37th.

Greece doesn't have waiting times, there hospitals and clinic are in a state of decay though. People recently operated are placed on cots in the hallway and medication is scarce. I dont think Canada does that. So what is the methodology of WHO when comparing health systems?
 
bluealberta
#16
Quote: Originally Posted by I think not

There is no perfect system Jay. Even the French being #1 according to WHO, have their problems.

I've been to Greece and stayed there for a bit, WHO ranks them 14, Canada ranks 30th and the US ranks 37th.

Greece doesn't have waiting times, there hospitals and clinic are in a state of decay though. People recently operated are placed on cots in the hallway and medication is scarce. I dont think Canada does that. So what is the methodology of WHO when comparing health systems?

That is a good question, and what bias' are these people using? It bothers me when people can only describe Canada has "A good health care system", when they are asked what it is to be Canadian. Of course two other responses are "We have good beer" (which is true), and "We are not American", which unfortunately, is also true
 
I think not
#17
Blue, do you know what the tax rate is for the Canadian Medicare System?
 
bluealberta
#18
Quote: Originally Posted by I think not

Blue, do you know what the tax rate is for the Canadian Medicare System?

I am not sure what you are asking. As far as I know, we don't have one, but if anyone else knows, please correct me. What specifically are you referring to, tax on what, or for what?
 
I think not
#19
Quote: Originally Posted by bluealberta

Quote: Originally Posted by I think not

Blue, do you know what the tax rate is for the Canadian Medicare System?

I am not sure what you are asking. As far as I know, we don't have one, but if anyone else knows, please correct me. What specifically are you referring to, tax on what, or for what?

The Canadian Medicare System is funded by way of the taxpayers since it is public funding, does anyone know what percentage of tax that is? Or is it all just distributed off a general tax?
 
bluealberta
#20
Quote: Originally Posted by I think not

Quote: Originally Posted by bluealberta

Quote: Originally Posted by I think not

Blue, do you know what the tax rate is for the Canadian Medicare System?

I am not sure what you are asking. As far as I know, we don't have one, but if anyone else knows, please correct me. What specifically are you referring to, tax on what, or for what?

The Canadian Medicare System is funded by way of the taxpayers since it is public funding, does anyone know what percentage of tax that is? Or is it all just distributed off a general tax?

I see what you want. There is no specific amount of tax that is earmarked for health care. Basically, all our taxes go into one big pot to be distributed as the party of the day sees fit, or unfit, as the case may be. I suspect there may be a stat somewhere which would indicate the percentage of taxes paid which goes to health care, but I don't know where it is.

But anyway, if I pay $100 in tax, there is nothing set in stone that $10 of that has to go to the health care system. Maybe there should be something like this, then people would actually get more of an idea of what our "free" health care system actually costs.
 
I think not
#21
We can't make a comparison of costs to "consumer" then blue. You saw from the lists before what the averages are per state and national averages, HOWEVER, the US health care is a mix of public and private, so to say it costs an individual $2261 annually is not accurate either since a portion of the taxes goes to public health care.

If we use health care costs per capita that isn't an accurate assessment either because health care costs increase in the US but the taxes do not, so I'm sort of stuck here.
 
bluealberta
#22
Quote: Originally Posted by I think not

We can't make a comparison of costs to "consumer" then blue. You saw from the lists before what the averages are per state and national averages, HOWEVER, the US health care is a mix of public and private, so to say it costs an individual $2261 annually is not accurate either since a portion of the taxes goes to public health care.

If we use health care costs per capita that isn't an accurate assessment either because health care costs increase in the US but the taxes do not, so I'm sort of stuck here.

Well, there are two, I think, provinces who have health care premiums over and above the tax component, Alberta and Ontario. In Alberta, family coverage is approx. $1,000 per year, just slightly less, I believe. I don't know what it is in Ontario. So, if that helps at all, we pay $1000 for Alberta Health Care, plus our contributions by way of taxes. Damn, I wish I could find out what percentage of taxes collected actually goes to health care. Leave that with me and I will see what I can find. If there is one thing Canadians are **** about it is stats. Probably comes from being hockey fans, this year excepted. I'll get back to you, but maybe this info will help for now, and maybe someone in Ontario can provide their cost for OHIP, I think its called.
 
bluealberta
#23
I think NOt

It appears that only you and I really care about the health care issue. That could be because you are providing information that disputes all the crap the leftists put out here in Canada about how bad the US System is and how good ?? ours is. Anyway, thanks for what you did.
 
I think not
#24
It sort of sucks nobody wants to participate, I have much to learn from the Canadian aspect of health care, I find the fundamental principles to be noble, but it has inherent flaws as the US system does.

The biggest issue in th eUS are the uninsured and the overall costs as a "system". Other than that, those insured certainly have access to top notch health care.

Regarding the uninsured in the US, the number has swelled to 45 million. What is more interesting is when you breakdown the numbers. The Actuarial Research Corporation (ARC) estimates that about 9 million of these individuals actually were enrolled in Medicaid, but were categorized as uninsured in the Census survey. In the latest Census health insurance report, the Census Bureau acknowledges that the survey “…underreports Medicare and Medicaid coverage compared with enrollment and participation data from the Centers for Medicare and Medicaid Services (CMS).”According to ARC, this “Medicaid undercount” leads to an over-assessment of the uninsured population and needs to be taken into consideration when developing uninsured estimates.

While this view is shared by some policy analysts, others disagree and there is no consensus. It is important that this issue be resolved so that targeted solutions for the uninsured can be developed based on the most accurate data possible.

Interesting isn't it? And thats just one example.
 
bluealberta
#25
So if you are to believe the first statistic, the actual uninsured are around 35 million? And if I recall correctly, thise have access to the 1871 community hospitals or clinics around the country?

Here is another interesting stat that was just reported in the Calgary, Alberta news today. A new MRI machine has recently opened, in a private facility, if I remember right, and this one machine alone has reduced the wait times for an MRI exam from over 60 days to about 31 days, or roughly half. To me, this point out the total fallacy of the argument that private health care will ruin our system. Even if this was a facility that charged full pop for the exam, which it cannot under law, but even if it was, do you suppose the person who originally was told they would have to wait 60 days and now can have it in a month really cares if someone jumped out of the public health line into another line, thus shortening the public line? I have never understood the reluctance of the leftists to recognise this, but then there is a lot about the leftists that baffle the hell out of me.
 
I think not
#26
Another stat blue, another 14 million are reachable through public programs in the US. They have access to it and dont know it. Medicaid and SCHIP (State sponsored)
 
bluealberta
#27
Quote: Originally Posted by I think not

Another stat blue, another 14 million are reachable through public programs in the US. They have access to it and dont know it. Medicaid and SCHIP (State sponsored)

So the actual number of uninsured, if I have done the connecting math correctly, now would be in the 20-25 million range? And these would still receive medical care without cost at the public hospitals or clinics?

Not do diminish the 20-25 million, because it is still a lot, but it is a far cry from the 40 million consistently quoted by opponenets.

I really think both our countries need to explore a mix of public and private health care delivery to be as efficient as possible with the lowest cost possible. However, the mindset in Canada at present prevents even a discussion being started that includes private health care delivery as an option, even though about 40% of our health care is private now. This paradox is what drives people like me around the bend when discussing health care. The response is: "Yes, Health care needs reforms because there are problems, but do not even consider Private Health Care Delivery as an option". There are only two ways to decrease the waiting times we have in Canada, and they are tied together. We need more facilities and more health care practioners. One without the other is useless. And the cost to the taxpayer to build more facilities is enormous.
 
Reverend Blair
#28
There are plenty of ways to reduce wait times, Blue. The ones that include allowing your coveted private care have been shown to push per capita costs up considerably while taking the best doctors out of the public system.
 
bluealberta
#29
Quote: Originally Posted by Reverend Blair

There are plenty of ways to reduce wait times, Blue. The ones that include allowing your coveted private care have been shown to push per capita costs up considerably while taking the best doctors out of the public system.

Damn,and just when there was an actually civilized discussion between people about ideas to reform health care. If you care to read everything, I said that more facilities without more doctors does not make sense, just as more doctors without facilities makes no sense. BTW, a doctor does not operate an MRI machine, so your argument there is moot.

Why do you insist on letting people die waiting for services when there are other options available that will reduce wait times? What solutions do you have that would decrease wait times? And please, don't give the usual simplistic answer about building more hospitals with public funds. There are already facilities out there that can be used without building more. And even if you want to build more hospitals, that will obviously take money from somewhere else in the health care system, or are you advocating increasing taxes even further to build these buildings?

Of course, if the gun registry had not had an overrun from $2milion to $2billion, we could have used some of that money. If we had not lost $2billion on the HRDC boondoggle, we could have used that money. If we did not currently have a $46billion dollar surplus in the EI fund taken from employers and employees we could have used some of that money. If the Liberals had not been caught with their hands in the cookie jar taking millions of dollars, we could have used that money. If the Liberals had not cancelled a helicopter purchase costing us millions of dollars, we could have used that money. And so on.

But then again, why look at any of that, lets just tax the hell out of the citizens because some of them are so stupid that the Liberals can do all the above and still get reelected. Of course, when there are others in the country who will blame the conservatives for all the above, then the Liberals know for sure that Barnum was right about suckers.
 
Reverend Blair
#30
Whatever, Blue.
 

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