Sudden Confusion

That's also on the IRS web site.

They only have to make sure the co-pays and deductibles fall within the IRS limits. That's not so hard to do when writing a plan. Why should it add cost?

That's only a small part. After a trip to the ER you have your bill that you paid your $180 or whatever. But afterwards bill flow into your mailbox. More copays and deductibles for this, that and the other thing.

Of course not. But I would expect them to _know_ their _own_ costs. For example, one guy said a sigmoidoscopy which you should have after a certain age is free because it's preventative. Next Kaiser agent says it's probably not free on my plan. The third says that's never a charge, no copay. Then comes a letter ... 260 bucks copay, with payment sub attached. So I called. Got another two conflicting answers, filed a grievance. Several months later some of the costs were reversed. Others weren't where they clearly said it would. Sorry, but that's not what I'd call transparency.

I have numerous stories like that here, including the paperwork (bills).

That 2% number is incorrect. It is way higher. Not only must docs pay and then of course bill exorbitant malpractice premiums but the real issue is over-use of resources to avoid lawsuits. We visit sick people and the elderly, mostly as volunteers. Ever wondered why there is a flurry of nurses constantly tapping away on keyboards behind counters while nobody has time to bring a bed pan? Then tons of excess procedures, excess medication, and so on.

I work in the medical device industry and one doc told me this straight into my face: "I have to buy the most expensive and luxurious ultrasound machine there is. Oc course a cheaper one is just fine but this is to avoid lawsuits, to show I provided the best". That makes me sick.

We need tort law reform, not just in med. And in the current political climate were aren't going to get it for obvious reasons.

Canadians have a healthier lifestyle than we do. The core reason for higher life expectancy is not health care, it's this:

The issue is when you do get seriously sick, like with cancer, the picture completely changes:

Now you might question this publication but they cite facts that have been thoroughly established by the medical profession.

Exactamente.

It says that we have access to such clinics while in other countries only the upper class has that access. The people with enough money.

Many Canadians do. As evidenced by the fact that many take out the US-side insurance plan. They come all the way down to here, mostly in winter if the ailment can wait, because Rochester ain't much "balmier" in its weather than places such as Regina. You can easily spot them, like when they ask "aboot the appointment time" :-)

In Canada you often travel onto a waiting list when that happens.

I work in the medical device industry, mostly on the design of higher-end stuff. Devices docs only need when things are looking rather bleak. Since we must closely work with clinical staff it becomes evident rather quickly where the bulk of the machines go. The number of high-end machines per 100,000 citizens is strikingly different between Canada and the US. And this is not over-treatment because of malprctice, because the stuff I work on is usually used on cases where you simply don't have a choice. My impression is that the Canadian system does not have the budget to provide this level of care.

It can hardly become any more clear than in the link below, this takes the cake:

That is not true. Never was. You probably confuse this with flexible spending accounts (FSA) at work. Those are or at least used to be "use it or lose it", so I never had one as an employee. Because as a healthy person I did not see a point in being forced to pay for some medical stuff I don't need by Dec-31 or "donate" all my saved money to an insurance company. Whoever invented such a nonsensical product must has smoked something strange.

Has this changed?

Except for a (IMHO a bit steep) $24/year fee for each of our HSA accounts all the money has always rolled over into the next year. As it should.

Not quite. I lived in Germany for decades. Most people can opt to move to private insurance and some government employees have to. But it's still a nationalized system in that the law says you must have insurance and employers must provide health coverage. Unless something has changed in the last 15 years employers are obligated to pay 50% of the premiums.

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But it does seem to compare apples and pears. Skin cancer is the most common cancer, and rarely kills anybody. It's almost twice as common in the US as in Europe., which does help make the US cancer survival rates look better.

In fact US cancer survival rates for specific cancers do tend to be marginally better than they are in Europe - this is one area where expensive test-for-everything medicine does pay off, because detecting some cancers early does lead to better survival rates. For nasty stuff like small-cell carcinoma of the lung (which is what smokers get) early detection doesn't help much but for quite a few cancers it can make a real difference.

y if he is pretty goddam sick,

He wanted heart valve replacement surgery via catheter, rather than via open heart surgery. I've had my aortic valve replaced by open heart surgery and it's a big operation and you spend months convalescing afterwards. The advantage is that the surgeon can pick out every last bit of the calcified tissue that was stopping the original aortic valve from working, so the chances of post-operative complications are a lot less. For very elderly patients, for whom open heart surgery would be life threatening, doing the valve replacement via a catheter is - overall - safer than open-heart surgery, but Danny Williams wasn't in that group, or anywhere near it.

You can get the operation in Canada, but nobody was irresponsible enough to offer it to him. The US offers a a wider choice of surgeon.

That wasn't about what what technically available but rather about how willing surgeons were to go along with a patient who wanted an easier, but more dangerous procedure.

-- Bill Sloman, Nijmegen

People who know the difference between "to" and "too" have been trying to educate me. The more I learn, the more I get to wonder about the short term viability of the US.

-- Bill Sloman, Nijmegen

Tell that to the widow of a former neighbor.

According to the European Journal of Cancer the 5-year colon cancer survival rate in Europe is 43%. In the US it is 62%, and that data is from the same European journal, not an American source. I'd say this is rather significant and colon cancer is one of the major killers in today's society.

It is similar for breast cancer and prostate cancer.

How do we get there? If I am only a couple weeks late sending in my yearly stool sample they start pestering me with emails and phone calls until I do. Then the sigmoidoscopy. Ok, it's a bit uncomfortable but considering the benefits I am certainly not complaining. Until a few years ago when it was already routine screening here it seems the Canadians were still "discussing" it:

It is not at all irresponsible. In the US, the patient has a say in his treatment. In Canada, less so.

There is a huge difference between the availability of cutting edge procedures in the US and Canada. I work in medical devices and know where the bulk of the sales happens. If you have one machine for 100,000 people in one country and 10 machines in another then it's pretty clear who has the better options. And none of this is for cosmetic or elective stuff but mostly for things where people are hanging on for dear life.

I am sure you know to much about that subject!

Jamie

Did you have difficulties understanding me?

Do I need to use the generic sign language, you so much deserve?

I can start with the more pleasant style of the language and if you still have problems hearing that, I can also turn it up for you, and if you are so ignorant as to not comprehend the meaning of that? Read below.

As one of my old, gone to the other side, italian engineer friend used to say, "Up your Ass with a piece of Glass"

Jamie

The tort lawsuits are there because people sue for entirely rational reasons: since they have no guarantee of continuity of care (preexisting condition, vagaries of insurance coverage), suing for a lot of money is the only way to guarantee long-term care.

If there was a comprehensive guarantee of medical care, there would be no incentive to sue. People would sue less, and laws to limit lawsuit would be much easier to pass.

Not really. Some 40% of the money collected in malpractice suits stays with the lawyers, and they do not want to lose that income.The insurance companies who sell malpractice insurance also have an interest in maintaining a market for their product.

A considerable number of ambulance-chasers of various sorts would have to find other work if tort reform ever got to the statute book, and they have every reason to lobby against any such reform. The US political system is a forum where well-funded lobbyists seem to be unusually effective (when the US is compared with other advanced industrial countries).

-- Bill Sloman, Nijmegen

The reason is different: Lawyers can advertise and work on "contingency". That is illegal in most countries and should be here as well. Almost every night during the evening news there are lawyers touting that if you own this or that call us. Because they smell loot, they often get to keep 30-40%. It has nothing to do with medical per se or with long term care.

If someone wins millions for some elective cosmetic surgery that they say has gone sub-optimal, that's extortion of a system to me.

They'd lose a lot on each patient but make it up on volume?

The cost of insurance over and above the payout includes their profit.

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Then we'd go back to the "no pre-existing conditions" days. Once you dropped the policy, you'd never get another, and the taxpayer would end up funding your care.

Will the care be worse or better? If worse, then more desirable employees would get a better deal.

KAISER PERMANENTE IS NOT A PHYSICIAN-OWNED HOSPITAL!

Oddly enough, physician-owned hospitals are owned by one or more physicians. They tend to provide limited, high-profit services. They cherry-pick business from existing full-service -- either non-profit or for-profit -- hospitals in their area, leaving these others to perform the costly services.

Who will bail out the hospitals who lost their high margin business? You and me, buddy.

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If American health care providers could simply manage not to seriously injure their patients, in such a manner that a jury award is almost a slam-dunk, then the lawyers' business would go away. Plaintiff's lawyers are entrepreneurs who won't invest in a lawsuit unless a payout is probable. OTOH, defendants' lawyers get paid by the hour, win or lose.

Let the government take over the malpractice insurance business.

"Tort reform" so far has meant limiting compensation for injuries caused by health care providers. Especially onerous are damages done to young people who must live most of a lifetime with some physician or hospital-caused disability.

The poor are in a bad place to wine and dine their leaders.

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Who pays for the damages caused by doctors and hospitals in those other countries?

They work strictly on commission. If they don't win, they don't see a dime for their efforts. Is this not the American way? So, to be profitable, the injury produced by the health care providers must be severe, and their responsibility crystal-clear.

So plastic surgeons should be free to hack up their patients?

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Right. The real answer is that they exist, that marginal improvements are realized, but somehow they haven't spread. Congress proscribes offerings across state borders, limiting interstate commerce--maybe that's it. Ironically, promotion of interstate commerce is Congress' chief constitutional rationale for their unAffordable Care Act.

Obviously. And their expenses too.

Paying middlemen to rent offices, do useless paperwork, and then pay your doctor will always cost more than simply paying the doctor yourself.

-- Cheers, James Arthur

That, however, is not what Obamacare says. Obamacare says you can't be denied, and that you pay a trivial penalty for not having insurance.

It's a shell game, but essentially no different. Why shouldn't physicians be allowed to pool together and invest in hospitals?

So? Businesses always try for more, and, if margins are excessive, competition trims them back. Unless you regulate away all the competition, that is.

Not me. If Obamacare stands, you'll pay for me, and everyone else.

-- Cheers, James Arthur