Universal Medicare: good idea?

[Machjo]

Considering how internationally mobile Canadian society has become, I was wondering about your thoughts on the following Medicare proposal or similar:

The government would establish its own medical insurance plan and would require all Canadian residents (and all entering Canada) who do not have their own compatible private insurance plan to purchase the government plan. It would also have the option of charging according to lifestyle choices.

This insurance, however, would be universal in the following senses:

1. Anyone in the world could purchase this plan.

2. Any hospital in the world could opt into the voucher programme offered by the Canadian Medicare Insurance Plan, and would have to abide by the two rules of accepting all who are covered by this plan and accepting no payment other than by way of the vouchers provided by the plan. (within Canada though, only voucher hospitals would be allowed to offer non-consensual medical services).

This plan however would still be defective (for lack of a better word) in that it would not guarantee a person coverage in any non-voucher hospital and, in the case of members outside of Canada, would not guarantee protection from the potential costs of non-consensual medical services in non-voucher hospitals.

One way of fixing this defectiveness would be by establishing agreements with other countries to introduce a similar plan within their own countries which would be compatible with the Canadian one.

One advantage with this that I could see is that it would allow Canadians under this plan to exploit less expensive medical coverage abroad. For example, let's say the government plan gives a voucher of $100.00 Canadian for a particular service, clearly that CAD100.00 will likely go farther in small town India than in Tokyo, or even Toronto. Granted, a person would still have to pay his own way to India, but while this might not be worthwhile for CAD100.00, it could be worthwhile for a few thousand Canadian dollars. Maybe not to India, but Mexico for example.

Of course all participating hospitals would need to meet minimum standards, but even with that it would likely be cheaper in some countries.

Another advantage is by way of international aid. This would essentially reduce Canada's need to provide international aid to other countries as it would provide them with a new source of revenue. I'm sure some hospital in Mexico or Puerto Rico would see an opportunity in this.

And as for this costing the taxpayer money, that would be a non-issue since no tax money would go towards this. We'd each be paying our own private insurance. Now of course the government might pay for the poorest of Canadians, but then they're not the ones who can afford to fly abroad anyway, so it's more or less guaranteed that they'll stay in Canada or at the most, hop the border into the US if they live in a Canadian border town.

What would be your thoughts on such a medical system?

 

[Bar Sinister]

Interesting idea, however, fully funded government plans are more effective in that premiums do not have to be collected. A problem with the payment of premiums in a universal system is what to do with those who do not pay. Do we deny them medical services or spend millions on expensive collection services chasing them down.
I do like the idea of selling premiums to foreigners. I expect we would get a huge number of clients from across the border from Americans fleeing their highly inefficient and expensive system. The key with selling to foreigners would be to price the premiums high enough to ensure that the system did not lose money, but low enough to attract users.
I also like the idea of medical vouchers. Even now Canadians are traveling to places like India in order to receive faster medical services at lower prices. Encouraging such medical tourism would lower costs in Canada and take also pressure off medical services. The key would be to ensure that Canadians seeking medical services outside the country were going to accredited physicians and not some quack offering psychic surgery.

 

[Machjo]

Interesting idea, however, fully funded government plans are more effective in that premiums do not have to be collected. A problem with the payment of premiums in a universal system is what to do with those who do not pay. Do we deny them medical services or spend millions on expensive collection services chasing them down.

Valid point. I suppose one solution would be to to take it right off a person's pay check unless he actively opts out of it in which case he'd then have to provide proof of compatible private insurance.

I do like the idea of selling premiums to foreigners. I expect we would get a huge number of clients from across the border from Americans fleeing their highly inefficient and expensive system.

I don't know if we would get a HUGE number, but some might be interested. Remember that according to the proposal in the OP, it does have some flaws too. For those living, travelling, working, or studying within Canad's borders who are looking for essential coverage, they'd likely opt for the public plan, and it certainly would cover all essentials as long as they remain in Canada.

If they should cross Canada's borders into the US, let's say, that insurance plan wouldn't be so ideal anymore. First off, not many US hospitals would opt into the plan since by doing so they'd have to forfeit the right to collect payment other than by way of vouchers. This would mean that a person in the US who wishes to benefit from this plan would have to either cross the border into Canada or possibly have to travel to another town where a voucher hospital exists. I could see such hospitals choosing to opt in if they're near the Canada-US border or in a major Canadian tourist area such as fort Lauderdale or thereabouts. And even there most likely only a handful of hospitals would opt in.

Add to that that while in the US you would always risk being subjected to non-consensual medical care from a non-voucher hospital.

All this being said, some US border towns might (and I do stress 'might') opt in. So in spite of the flaws, it certainly has clear advantages. But like any other insurance plan, it too would have its pros and cons.

The key with selling to foreigners would be to price the premiums high enough to ensure that the system did not lose money, but low enough to attract users.

That would be the idea. Not only for foreigners though, Even for Canadians, it would be sold at a free-market non-subsidized rate. As for tax money going into it, that would only be in the case of social services paying for a poor person's premiums.

And to keep costs low, coverage would apply only at voucher hospitals, and though no hospital would be forced to opt in, since most people would likely choose to go with the public plan, most hospitals would see that they would stand more to gain financially by opting in. Of course though since the voucher programme would cap the value of the voucher, voucher hospitals would naturally become more focussed on essential services. For non-essential services, one may prefer either switching to a private insurance plan or otherwise pay out of pocket to go to a private non-voucher hospital.

I also like the idea of medical vouchers. Even now Canadians are traveling to places like India in order to receive faster medical services at lower prices. Encouraging such medical tourism would lower costs in Canada and take also pressure off medical services.

Just to clarify, I would disagree with the government encouraging such medical tourism. My intent rather was for the government to allow it, not encourage it. But otherwise you bring up some good points.

The key would be to ensure that Canadians seeking medical services outside the country were going to accredited physicians and not some quack offering psychic surgery.

Of course only voucher hospitals and voucher clinics could benefit from these vouchers. And in order to opt into the voucher programme, they'd need to meet certain minimum requirements. Of course we would not discriminate in that they'd simply be expected to meet the same standards as any other hospital that chooses to opt in, whether in Canada or abroad.

Another advantage that I see is that a number of countries could easily unite their national Medicare programmes. Clearly it would be limiting if those covered by the Canadian plan could go only to Canadian-voucher hospitals, and Britons to British ones, and Frenchmen to French ones, etc. If a number of countries could all agree to a common insurance plan, all charging the same price, then we could establish a common plan, and all members of this plan would be covered by any voucher hospital in the world that's opted into this same plan. Many European countries could potentially be interested in this. And who knows. The US might too.

 

[Trex]

Considering how internationally mobile Canadian society has become, I was wondering about your thoughts on the following Medicare proposal or similar:

The government would establish its own medical insurance plan and would require all Canadian residents (and all entering Canada) who do not have their own compatible private insurance plan to purchase the government plan. It would also have the option of charging according to lifestyle choices.

This insurance, however, would be universal in the following senses:

1. Anyone in the world could purchase this plan.

2. Any hospital in the world could opt into the voucher programme offered by the Canadian Medicare Insurance Plan, and would have to abide by the two rules of accepting all who are covered by this plan and accepting no payment other than by way of the vouchers provided by the plan. (within Canada though, only voucher hospitals would be allowed to offer non-consensual medical services).

This plan however would still be defective (for lack of a better word) in that it would not guarantee a person coverage in any non-voucher hospital and, in the case of members outside of Canada, would not guarantee protection from the potential costs of non-consensual medical services in non-voucher hospitals.

One way of fixing this defectiveness would be by establishing agreements with other countries to introduce a similar plan within their own countries which would be compatible with the Canadian one.

One advantage with this that I could see is that it would allow Canadians under this plan to exploit less expensive medical coverage abroad. For example, let's say the government plan gives a voucher of $100.00 Canadian for a particular service, clearly that CAD100.00 will likely go farther in small town India than in Tokyo, or even Toronto. Granted, a person would still have to pay his own way to India, but while this might not be worthwhile for CAD100.00, it could be worthwhile for a few thousand Canadian dollars. Maybe not to India, but Mexico for example.

Of course all participating hospitals would need to meet minimum standards, but even with that it would likely be cheaper in some countries.

Another advantage is by way of international aid. This would essentially reduce Canada's need to provide international aid to other countries as it would provide them with a new source of revenue. I'm sure some hospital in Mexico or Puerto Rico would see an opportunity in this.

And as for this costing the taxpayer money, that would be a non-issue since no tax money would go towards this. We'd each be paying our own private insurance. Now of course the government might pay for the poorest of Canadians, but then they're not the ones who can afford to fly abroad anyway, so it's more or less guaranteed that they'll stay in Canada or at the most, hop the border into the US if they live in a Canadian border town.

What would be your thoughts on such a medical system?

Either I am confused reading this or you are confused about how Canadian medical coverage works.

I am one of those internationally mobile people you are talking about.
I have worked outside of Canada for about 18 years.

Canadian medicare covers you in foreign countries for the amount that would be paid out in the Canadian medical system.
They will not cover anything not covered outside of the Canadian medical system coverage brackets.
Nor will they agree to have any services performed that can be done cheaper or more efficiently ( thats a laugh right there) in Canada.
So if a bed in a hospital is evaluated at $150 a night by Canadian Medicare and you pile up a car in Vegas and the hospital there charges you $1500 a night, well hey, you as a Canadian are on the hook for about $1350 a night.
And thats why Canadian tourists going to other countries pick up additional travel insurance.
Also having insurance that will agree to hire a Lear, if needed, to haul your sorry, sick ass back to Canada from say Somalia is not a bad idea.

So Canadians are already covered.
Sort of.

Next up is the foreigners.
As Canadians we are having problems funding our own medical system for our own people.
Funding our own medical system internally is a huge chunk of Federal and Provincial taxes.
Why would we offer it out to others who don't even live here?
It would instantly bankrupt us.

Or are you suggesting Canada should create a for profit health care system for foreigners?

We kind of do have that.
If as a foreigner you want to come to Canada and pay market rate ( thats big bucks, private health care rates) there are private Canadian clinics that will do a procedure for you.

So I guess what I am saying is I don't really follow what, outside the existing Canadian system, you are promoting.

Trex

 

[Machjo]

Either I am confused reading this or you are confused about how Canadian medical coverage works.

I am one of those internationally mobile people you are talking about.
I have worked outside of Canada for about 18 years.

I'd worked abroad too and indeed I got my ow insurance.

Canadian medicare covers you in foreign countries for the amount that would be paid out in the Canadian medical system.
They will not cover anything not covered outside of the Canadian medical system coverage brackets.
Nor will they agree to have any services performed that can be done cheaper or more efficiently ( thats a laugh right there) in Canada.
So if a bed in a hospital is evaluated at $150 a night by Canadian Medicare and you pile up a car in Vegas and the hospital there charges you $1500 a night, well hey, you as a Canadian are on the hook for about $1350 a night.
And thats why Canadian tourists going to other countries pick up additional travel insurance.
Also having insurance that will agree to hire a Lear, if needed, to haul your sorry, sick ass back to Canada from say Somalia is not a bad idea.

So Canadians are already covered.
Sort of.

Next up is the foreigners.
As Canadians we are having problems funding our own medical system for our own people.
Funding our own medical system internally is a huge chunk of Federal and Provincial taxes.
Why would we offer it out to others who don't even live here?
It would instantly bankrupt us.

Or are you suggesting Canada should create a for profit health care system for foreigners?

We kind of do have that.
If as a foreigner you want to come to Canada and pay market rate ( thats big bucks, private health care rates) there are private Canadian clinics that will do a procedure for you.

So I guess what I am saying is I don't really follow what, outside the existing Canadian system, you are promoting.

Trex

I answered at least most of those questions in my second post in this thread, so you can just read that. The introduction of voucher hospitals would give the benefit, at least in those cases where the Canadian is conscious and can make up his own mind, to have a cheaper option nearby... in some cases, and again this would not protect him if he's unconscious. So certainly even with this proposed plan, a Canadian would still want to buy his own private insurance or, if available, buy into the foreign national insurance plan for while he's travelling. That does not change however the fact that for certain preplanned operations he could possibly save money by going abroad.

Again, as mentioned in my second post in this thread, the plan is not without its flaws, but does solve some issues none-the-less. And as mentioned in my second post, no plan is ever perfect for all situations.

 

[Machjo]

And to Trex, the main advantage I could see would be if other countries decided to integrate their system with ours. For example, if the US decided to introduce a compatible system, then the same public insurance could cover a person across Canada and the US. And of course the more countries should opt in, the better.

But even if a country does not opt in, while you're perfectly correct in that a person would then need additional private insurance to at least cover emergency services, a person simply going for a planned operation could opt for poorer country. For example, a voucher hospital in Mexico might in fact be able to provide higher quality services at the same voucher value than one in the US or Canada.

 

[Machjo]

I do like the idea of selling premiums to foreigners. I expect we would get a huge number of clients from across the border from Americans fleeing their highly inefficient and expensive system. The key with selling to foreigners would be to price the premiums high enough to ensure that the system did not lose money, but low enough to attract users.

Now that I think about it, maybe I was wrong. You may be right in saying that a huge number of Americans would join in, and here's why I say this:

The US is still proving highly resistant to any sufficient government intervention in controlling health care costs. As a result, some local border towns on the US side of the Canada-US border might choose to jump on board altogether, whereby they'd pass local laws allowing only voucher hospitals to provide non-consensual medical services and require all locals to purchase some kind of insurance. This would certainly increase the availability of voucher hospitals and since the Canadian plan would be cheaper than private plans (though granted the Canadian plan would essentially be considered a private plan in the US since Canada has no governmental authority in the US and so would essentially be treated as a corporation like any other), most locals would simply opt for that one.

Once this plan would become well established in US border towns, it could then possibly start spreading slowly ever farther away from the border. Non-voucher hospitals would remain of course, but for those who cannot afford other health care plans, they'd choose to buy into the Canadian one. Granted, the other plans would be like the Rolls Royces of health care plans, while the Canadian one would be like the bicycle of health care plans, but would still be functional and cover all the essentials. Overall though, the Canadian one would easily take over the lower to middle classes. Though the government might make a minimal profit per person, you could imagine the profit it would make overall.

Before you know it, the US government would finally smarten up and create a plan of its own before Canada ends up controlling the majority of the US market.

 

[TenPenny]

Canadian medicare covers you in foreign countries for the amount that would be paid out in the Canadian medical system.

That also depends on how long you are outside of the country; I believe that in NB, if you live outside of the country for more than 6 months of the year, you are no longer covered.

 

[Machjo]

That also depends on how long you are outside of the country; I believe that in NB, if you live outside of the country for more than 6 months of the year, you are no longer covered.

That's not country, but province I believe. If I remember correctly, after 6 months out of Ontario, you're no longer covered by OHIP.

Also, if you're covered by OHIP and fall ill in Quebec, OHIP will cover your bills up to the amount it would cover them in Ontario. If it's different in Quebec, you may have to pay for some services.

Canadian health care as it stands at the moment is full of holes and is not as universal as we might believe. As long as you stay within your provincial boundaries, you're fine. But the world has become more interconnected.

And as mentioned above, the proposal in the OP is certainly not a panacea but would still extend coverage at least a little more than it does now.

 

[L Gilbert]

I have something similar: private and public insurance covering procedures done by both private and public entities with gov't picking up the premiums for those that cannot pay them, and chipping in for those that can only pay some of the premiums, and letting the wealthier pay their own premiums.
Simpler is better.

 

[SirJosephPorter]

Considering how internationally mobile Canadian society has become, I was wondering about your thoughts on the following Medicare proposal or similar:

The government would establish its own medical insurance plan and would require all Canadian residents (and all entering Canada) who do not have their own compatible private insurance plan to purchase the government plan. It would also have the option of charging according to lifestyle choices.

This insurance, however, would be universal in the following senses:

1. Anyone in the world could purchase this plan.

2. Any hospital in the world could opt into the voucher programme offered by the Canadian Medicare Insurance Plan, and would have to abide by the two rules of accepting all who are covered by this plan and accepting no payment other than by way of the vouchers provided by the plan. (within Canada though, only voucher hospitals would be allowed to offer non-consensual medical services).

This plan however would still be defective (for lack of a better word) in that it would not guarantee a person coverage in any non-voucher hospital and, in the case of members outside of Canada, would not guarantee protection from the potential costs of non-consensual medical services in non-voucher hospitals.

One way of fixing this defectiveness would be by establishing agreements with other countries to introduce a similar plan within their own countries which would be compatible with the Canadian one.

One advantage with this that I could see is that it would allow Canadians under this plan to exploit less expensive medical coverage abroad. For example, let's say the government plan gives a voucher of $100.00 Canadian for a particular service, clearly that CAD100.00 will likely go farther in small town India than in Tokyo, or even Toronto. Granted, a person would still have to pay his own way to India, but while this might not be worthwhile for CAD100.00, it could be worthwhile for a few thousand Canadian dollars. Maybe not to India, but Mexico for example.

Of course all participating hospitals would need to meet minimum standards, but even with that it would likely be cheaper in some countries.

Another advantage is by way of international aid. This would essentially reduce Canada's need to provide international aid to other countries as it would provide them with a new source of revenue. I'm sure some hospital in Mexico or Puerto Rico would see an opportunity in this.

And as for this costing the taxpayer money, that would be a non-issue since no tax money would go towards this. We'd each be paying our own private insurance. Now of course the government might pay for the poorest of Canadians, but then they're not the ones who can afford to fly abroad anyway, so it's more or less guaranteed that they'll stay in Canada or at the most, hop the border into the US if they live in a Canadian border town.

What would be your thoughts on such a medical system?

That would be an interesting idea, except for one thing. The insurance plan must be government insurance plan, I don’t think we want private, for profit insurance companies here in Canada (unless there are only one or two big ones, their plans must be approved by the government to make sure that it is very similar to government plans).

In a two tier system, you pay for the government health care as well as you buy private insurance. But what you are proposing is something different.

As to collecting premiums, they could be most effectively collected when we file the income tax return, the way they collect Ontario health care premium currently. That would take care of any concerns regarding non payment of premiums etc. Those whose taxable income is below a certain threshold would be exempted.

 

[Machjo]

That would be an interesting idea, except for one thing. The insurance plan must be government insurance plan, I don’t think we want private, for profit insurance companies here in Canada (unless there are only one or two big ones, their plans must be approved by the government to make sure that it is very similar to government plans).

Why must they be similar as long as they are compatible?

In a two tier system, you pay for the government health care as well as you buy private insurance. But what you are proposing is something different.

Not that different. Even if you opt out of the government plan, you still have to pay taxes part of which go towards paying to cover those who can't afford their own insurance. So you're still not getting out of paying for other people's insurance there.

But I suppose your proposal could work too, whereby whether you have your own private plan or not, you still have to pay for the public one. Though in the end, that would more or less come out to the same thing as paying more in taxes.

As to collecting premiums, they could be most effectively collected when we file the income tax return, the way they collect Ontario health care premium currently. That would take care of any concerns regarding non payment of premiums etc. Those whose taxable income is below a certain threshold would be exempted.

Could work. I'm just wondering though how popular such a plan would be across the border. On the one hand, since it would cover only voucher hospitals, and outside Canada's borders the government would have no control over where you end up if you're subjected to non-consensual care, the plan is faulty at least on that front. On the other hand, it would be a more affordable plan than the current US ones, and so some Americans might view it as a useful general plan, though they might want to supplement it with another private plan that also covers the risk of ending up in a non-voucher hospital in the event of non-consensual care being provided.

It's got pros and cons, but I'm just not sure which way it would really swing in the end across the border. Any thoughts on that?

 

[Machjo]

I do like the idea of selling premiums to foreigners. I expect we would get a huge number of clients from across the border from Americans fleeing their highly inefficient and expensive system. The key with selling to foreigners would be to price the premiums high enough to ensure that the system did not lose money, but low enough to attract users.

I'd read today (not necessarily from a reliable source but maybe someone here could confirm its veracity) that US states are very protected of their health insurance industry. Apparently if you live in one state, it's difficult for you to buy insurance in another state. If that's true, then indeed it would be very difficult for Canada to sell premiums in the US, unless it could reciprocate by allowing US insurance companies to sell theirs in Canada. Though that would not necessarily be a bad idea as long as the public option remains in existence.

 

[ironsides]

I'd read today (not necessarily from a reliable source but maybe someone here could confirm its veracity) that US states are very protected of their health insurance industry. Apparently if you live in one state, it's difficult for you to buy insurance in another state. If that's true, then indeed it would be very difficult for Canada to sell premiums in the US, unless it could reciprocate by allowing US insurance companies to sell theirs in Canada. Though that would not necessarily be a bad idea as long as the public option remains in existence.

If you have private health insurance in the U.S., you can travel anywhere in the U.S. and be covered. Now there you hit upon a great idea, sell a policy that would be good for North America maybe even Mexico. Not slighting Mexico, but no very little about them except you can just walk into a pharmacy and buy almost anything non-narcotic over the counter with no prescription. But I think Obama is about to put more control on what insurance policies we can buy because they will interfere with what his grand vision may be.

 

[SirJosephPorter]

Why must they be similar as long as they are compatible?

In a two tier system, you pay for the government health care as well as you buy private insurance. But what you are proposing is something different.

Not that different. Even if you opt out of the government plan, you still have to pay taxes part of which go towards paying to cover those who can't afford their own insurance. So you're still not getting out of paying for other people's insurance there.

But I suppose your proposal could work too, whereby whether you have your own private plan or not, you still have to pay for the public one. Though in the end, that would more or less come out to the same thing as paying more in taxes.



Could work. I'm just wondering though how popular such a plan would be across the border. On the one hand, since it would cover only voucher hospitals, and outside Canada's borders the government would have no control over where you end up if you're subjected to non-consensual care, the plan is faulty at least on that front. On the other hand, it would be a more affordable plan than the current US ones, and so some Americans might view it as a useful general plan, though they might want to supplement it with another private plan that also covers the risk of ending up in a non-voucher hospital in the event of non-consensual care being provided.

It's got pros and cons, but I'm just not sure which way it would really swing in the end across the border. Any thoughts on that?

I don't see it going down well across the border. Americans don't like to admit that somebody else could have a better idea than them.

 

[AnnaG]

In a two tier system, you pay for the government health care as well as you buy private insurance. But what you are proposing is something different.

I don't see it going down well across the border. Americans don't like to admit that somebody else could have a better idea than them.

8O You must have been American at some point. lol

Anyway, I like the mix of private/public insurance and public/private facilities. With just public insurance, the gov't would keep whittling down coverage and increasing premiums in order to cut costs. Private like to gouge. The mix, I think, would make gov't keep trying to match private in coverage and the private ones would want to match gov't pricing.

 

[AnnaG]

Oh yeah, there's another reason I like the variety ... I HATE monopolies.

 

[AnnaG]

A little news on the side:
apparently England nor Italy have very good orthopedics in comparison to Finland. Soccer star Beckham tore an Achilles tendon in a match in Italy, so they flew him to Finland to have it fixed. I wonder if average Canadians get flown around Canada to see the best physicians or if the practise is limited to just sports stars or politicians.

 

[TenPenny]

Top sports stars are money making machines, so their owners, I mean teams, do whatever they have to do to keep the machine running.

 

[AnnaG]

Top sports stars are money making machines, so their owners, I mean teams, do whatever they have to do to keep the machine running.

You missed my point. Politicians? Would you get the top notch surgeon looking after you like Harpy would?
Back to the sports star. Surgeon Joe has 25 patients to see on Monday. Sunday, Fred Sports Star injures himself in a manner the same as Surgeon Joe's patients. Surgeon Joe is the best in the country. Would Fred Sports Star's handler make an appointment and would Fred Sports Star squeeze into the lineup at Surgeon Joe's or would he have to wait?