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vnatale
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Re: Gold's Time To Shine?

Post by vnatale » Thu Jan 30, 2020 10:43 pm

Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
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Re: Gold's Time To Shine?

Post by Libertarian666 » Tue Feb 04, 2020 8:12 pm

MangoMan wrote:
Fri Jan 31, 2020 7:22 am
vnatale wrote:
Thu Jan 30, 2020 10:43 pm
Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
IDK about you, but I have lots of friends that have had various joints replaced, and from what I hear, you don't want the government deciding how much pain you are in or how you should walk 20 yards without a cane. I'd rather do the surgery when *I* think it's time, not some lackey with zero medical background. Ever been to the DMV? That's what government run anything will look like here. :'(
Don't worry, those rules are only for the "little people". High-level government employees will get the best of care.

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Re: Gold's Time To Shine?

Post by Kbg » Wed Feb 05, 2020 6:51 am

Are you guys self-insuring? I don’t know too many Americans whose insurance company doesn’t determine that.
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Re: Gold's Time To Shine?

Post by WiseOne » Thu Feb 06, 2020 7:57 am

There are delays to get approved for procedures etc in the US, for sure...it's due to insurance companies. It's a lot more capricious than is the case in Canada. The average wait times are probably lower than in Canada - but yes, a bean counter with a high school diploma somewhere IS deciding how much pain and disability you have to have before you can have a knee surgery, in BOTH countries - if you want someone else to pay for it. You are free to bypass this by paying for the procedure yourself.

I don't think the Canadian delays are about socialized medicine per se, as about how much money Canada is willing to spend on health care. It's about half as much as the US currently, and the number of specialists (like orthopedic surgeons) as well as resources (e.g. MRI scanners) are strictly limited. It's a bit unfair to compare care in country A with country B, if country B spends half as much. Canada could make those delays vanish by increasing health care spending, but that's a matter for the taxpayers (whose taxes would go up) to decide.
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Re: Gold's Time To Shine?

Post by mathjak107 » Fri Feb 07, 2020 4:51 am

an important note:

when it comes to medicare there can be a huge difference in your treatment allowed between not for profit gov't medicare vs a for profit insurer in an advantage plan as your gate keeper ...

those cheaper advantage plans are only good until they aren't .

If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.
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Re: Gold's Time To Shine?

Post by WiseOne » Fri Feb 07, 2020 7:17 am

Yup, otherwise known as the Laundry List of Nasty Private Insurer tricks. This is what everyone is faced with not just Advantage plan subscribers. Except you forgot to mention the out of network surprise trap.

Honestly, despite my otherwise Republican leanings I really would prefer a Canadian style system, both to work in and be a patient in. The Republican side of me would limit that to serious medical conditions (determined by ICD code not by a deductible system), and let routine stuff be handled by the free market on a cash basis. No insurers needed.
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Re: Gold's Time To Shine?

Post by Xan » Fri Feb 07, 2020 9:07 am

Kbg wrote:
Wed Feb 05, 2020 6:51 am
Are you guys self-insuring? I don’t know too many Americans whose insurance company doesn’t determine that.
I've mentioned here before how happy I am to be a member of Christian Healthcare Ministries, or CHM, a cost-sharing ministry for healthcare.

It isn't technically insurance, although it counts as being "insured" for purposes of the Obamacare mandate. Our family of 5 pays well under $6000 a year for unlimited reimbursement after with a $500-per-event deductible. And they cover maternity which even before Obamacare obliterated choices in the health insurance market was hard to find. I'm pretty sure that accounting for the three pregnancies they've paid us more than we've paid them, but we're happy to keep the service long-term.

We're completely free to negotiate with any provider of any service, with CHM there to reimburse us. It's a great system. (There are some caveats: they won't cover problems that are the result of substance abuse, for example.)
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Re: Gold's Time To Shine?

Post by Kbg » Fri Feb 07, 2020 9:56 am

I know some people who go this route and it seems to work well. The questions I’ve heard raised about CHMs is that they don’t really help if you have major (really expensive) healthcare issues...so if this is a reality, I would then say it is a restriction and your “choice” is circumscribed.

To me the whole choice issue is a gigantic red herring argument and an utter and total lie. Anyone who has commercial insurance knows they are restricted in their choices. They are restricted in how they are treated, they are restricted as to when they will be treated and they will follow the insurance companies’ policies for medical care and associated reimbursements and claims. Google searches will indicate doctors are widely dissatisfied with the system as they are for the most part completely controlled in how they do their jobs by insurance companies unless they are in the high end concierge business.

We have several friends who are Canadian (and formerly American) and from everything I’ve heard from them is that healthcare is really contingent on where you live. In some areas it is as good and rivals anything in the US and in other areas it can be overcrowded and old...kinda like rural healthcare in America which is quickly disappearing.

This whole topic is very complex and I would not pretend for a moment to have a solution for ...but pretty much all studies done on comparative healthcare systems indicate the following:

- The US pretty much leads the world when it comes to healthcare innovation and technology
- The US pays vastly more for worse healthcare results than other first world countries

My personal view is that we have the worst of both worlds...lots of government involvement with lots of corporate profit motive and the end result is a highly expensive mess. I also believe healthcare is fundamentally different than buying a pair of socks. There are things that do not function well in a completely free economy due to other factors involved and there is a public aspect to healthcare similar to utilities and other public infrastructure. I’m also confident that sometime in the future the whole thing is going to implode due to costs. It won’t go on like it is, it can’t.
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Re: Gold's Time To Shine?

Post by Xan » Fri Feb 07, 2020 11:41 am

Kbg wrote:
Fri Feb 07, 2020 9:56 am
I know some people who go this route and it seems to work well. The questions I’ve heard raised about CHMs is that they don’t really help if you have major (really expensive) healthcare issues...so if this is a reality, I would then say it is a restriction and your “choice” is circumscribed.
I haven't heard this, nor had problems with them paying, but I haven't had a "really" expensive event. It's possible that people who have had this might have paid for a weaker plan than they need.

Without the "Brother's Keeper" program, all the plans max out at $125,000 per illness. With Brother's Keeper, Bronze and Silver can have their maxes increase over time up to $1 million. Gold plus Brother's Keeper has no max, ever.

Gold plus Brother's Keeper is certainly the way to go. But the other options are much cheaper, and maybe that's how people get in a pickle. We pay less than $6,000/year for Gold plus Brother's Keeper for the whole family of 5.
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Re: Gold's Time To Shine?

Post by vnatale » Fri Feb 07, 2020 11:51 am

mathjak107 wrote:
Fri Feb 07, 2020 4:51 am
an important note:

when it comes to medicare there can be a huge difference in your treatment allowed between not for profit gov't medicare vs a for profit insurer in an advantage plan as your gate keeper ...

those cheaper advantage plans are only good until they aren't .

If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.
Am I to infer from what you state above that I made the better choice choosing a Medigap plan over an Advantage plan?

Vinny
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Gold's Time To Shine?

Post by Kbg » Fri Feb 07, 2020 3:07 pm

This is wholly anecdotal...

I spent 20+ years under a government medical system (military) and have been in the private system for coming up on 5 years. Some quick observations...

I can't really tell a difference for the most part...some small/key differences

+ Didn't have to hassle with insurance and bill tracking
+ Emergency room visits were MUCH faster
+ Way more attention paid to preventative healthcare issues (immunization notifications, annual check up notifications etc.)

- No doctor consistency (either you moved or they moved frequently)
- You were being treated by someone in training oftentimes
- You were kinda stuck with whatever doctor you were issued (at least for a while but it wasn't hard to switch)
- Extensive use of PAs and LPNs for primary care

Issues over getting a treatment or not getting one that wasn't "by the book"...haven't noticed a difference really. Some nameless face was going to review what the doctor proposed/you wanted and you could appeal a decision you didn't like to a different higher nameless face

Friends indicate their VA experience is quite variable. Some places not good, other places amazingly good which sounds a lot like my Canadian friends. Supposedly where I live it is pretty good; however, the VA is too far away from where I live so I never use it.

For me I'd say the biggest difference is that I have the same doctor going on 4 years now which I like a lot.
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Re: Gold's Time To Shine?

Post by dualstow » Fri Feb 07, 2020 3:11 pm

•^ Those pluses and minuses are referring to the military system, not the past five years, right, kbg?
Xan, this is turning out to be a good subthread. If you get a chance, would you mind splitting and calling it self-insuring or something? If you search for

Code: Select all

10:14
on the page before this or 'Canadian wait times', I think that's where the new branch begins.
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Re: Gold's Time To Shine?

Post by WiseOne » Fri Feb 07, 2020 3:53 pm

Xan, that is really good to know.

Some of the more well known health sharing ministries feature some potentially serious limitations - like, a limit of 120 days of drug coverage per occurrence. If you needed multiple rounds of chemotherapy after a cancer diagnosis or an expensive immunomodulator after, say, a liver transplant you'd really be up a creek.

It's hard to compare that to the numerous examples of people with legitimate private insurance who somehow got stuck with tens or hundreds of thousands in medical bills. It may well be that the risk of that happening with a cost sharing ministry is no worse than with traditional insurance, but it would be nice if someone studied that.
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Re: Health insurance

Post by Xan » Fri Feb 07, 2020 4:05 pm

That would be an interesting study, for sure.

And you're right: CHM doesn't cover "maintenance prescriptions", although they do cover "incident-related" prescriptions. I think the chemo in your example would be covered, but you may be right that the post-implant drug wouldn't. Huh.

Well, I'd just have Smithy ship me some from Canada if it came to it. :-)
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Re: Gold's Time To Shine?

Post by Maddy » Fri Feb 07, 2020 4:55 pm

WiseOne wrote:
Fri Feb 07, 2020 3:53 pm
Some of the more well known health sharing ministries feature some potentially serious limitations. . .
Yes, like having to go to church and to attest to a multi-faceted statement of belief with which a large number of Christians would not necessarily agree--requirements that apparently get interpreted and applied according to entirely subjective standards that have more to do with evangelical culture and the maintenance of institutional authority than anything else. It's a bit unnerving to have your health insurance depend upon somebody else's view of what is, and is not, sufficiently "Christian."

So far I've managed to keep my membership in a health sharing ministry without donning mascara and poofing my hair up with hairspray, although the thing about my not being "under a man" may eventually get me booted.
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Re: Health insurance

Post by WiseOne » Sat Feb 08, 2020 11:02 am

So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
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Re: Health insurance

Post by Maddy » Sat Feb 08, 2020 2:32 pm

WiseOne wrote:
Sat Feb 08, 2020 11:02 am
So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
I'd rather not say, WiseOne. At the moment this is the only type of health coverage I can afford, and I don't want to risk losing it. I would guess that even citing Bart Ehrman with intellectual enthusiasm (see the "Figuring Out Religion" thread) would be enough to get me booted. Suffice it to say that it's one of the more well-established and financially stable health sharing ministries.

P.S. I was being a bit tongue-in-cheek when I made the comment about not being "under a man." That's not, strictly speaking, a requirement of membership, but on one occasion I was indeed pulled aside by a church leader (who was required to sign off on my HSM membership form) for counseling on the subject of my marital status and the fact that I was not "under a man." The fact that I had actually chosen to be single was, according to this leader, "selfish." The whole episode was so completely bizarre that I was tempted to quip, "So I'm personally responsible for condemning some poor schlub to Saturday nights at home with his right hand?" But I didn't think my humor would be much appreciated.
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 8:08 am

ACA advocates really have no standing to lecture people on the "point of insurance", but they are correct that the point of insurance is to cover unexpected events which could bankrupt you. The lesson is to not pick a plan that has a coverage max.

Covering pre-existing conditions is very much not the "point of insurance", for example. But CHM does cover pre-existing conditions after a phase-in period.

It's true that they don't have to pay. That's what makes it technically not insurance. If they reneged on a promise, though, it would be the end of their service. Has anyone ever found one of these organizations to actually renege, or is every such "they won't pay" a result of buying insufficient coverage?
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 10:14 am

MangoMan wrote:
Thu Feb 13, 2020 9:07 am
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
Honest question: what happens if your traditional health insurance company goes bankrupt? Maybe it depends on who the president is. Under Obama, the federal government took care of everybody's car warranties when the manufacturer went under. (What a joke.) Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
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Re: Health insurance

Post by Maddy » Thu Feb 13, 2020 10:16 am

HSMs vary greatly both in terms of their scope of coverage and their financial stability, so it's hard to generalize. Several have supplemental programs that extend coverage beyond the ordinary limits. A number cover preexisting conditions after a certain number of years, or have phase-in periods. There's also a great deal of difference between organizations when it comes to how they are structured and in terms of who, exactly, is responsible for making payment. Some HSMs receive monthly premiums and make payments out of their reserves, while others merely act as administrators of a program whereby members make payments directly to other members.

There is a huge demand for alternatives to mainstream insurance, so new HSMs seem to be popping up everywhere. The problem is that they are largely unregulated--which is something that I expect will change in short order as more and more fly-by-night organizations enter the marketplace and state insurance regulators wise up to the fact that these organizations have developed some pretty creative ways of concealing the fact that, from a functional standpoint, they are very much in the business of selling insurance.

Meanwhile, I think it's unavoidable that many of these newer market entrants are going to find themselves with insufficient reserves to meet their contractual (or quasi-contractual) obligations to members. Even now, I frequently hear rumblings from members of even the most well-established HSMs about protracted delays in reimbursement or about repeated, unavailing attempts to communicate with the organization about unreimbursed claims. It's hard to know from these anecdotal reports just how prevalent these problems are, especially when members are required, as a condition of membership, to submit to a statement of faith that purports to bind them to highly controlled dispute resolution mechanisms and to preclude them from going through the usual legal and regulatory channels.
Last edited by Maddy on Thu Feb 13, 2020 10:32 am, edited 3 times in total.
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Re: Health insurance

Post by Maddy » Thu Feb 13, 2020 10:26 am

Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
Samaritan Ministries Intl. is an example of an HSM that acts as the administrator of a program whereby members make payments directly to other members. So a particular member's "need" of $5,000 might typically be met with the receipt of 20 different checks from 20 different members. If one of those 20 members fails to pay, then their share is assigned to another member. This way of structuring things removes the concern about insufficient reserves and greatly reduces the risk of non-payment.
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Re: Health insurance

Post by InsuranceGuy » Thu Feb 13, 2020 11:31 pm

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Re: Gold's Time To Shine?

Post by blackomen » Sat Feb 15, 2020 1:12 pm

MangoMan wrote:
Fri Jan 31, 2020 7:22 am
vnatale wrote:
Thu Jan 30, 2020 10:43 pm
Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
IDK about you, but I have lots of friends that have had various joints replaced, and from what I hear, you don't want the government deciding how much pain you are in or how you should walk 20 yards without a cane. I'd rather do the surgery when *I* think it's time, not some lackey with zero medical background. Ever been to the DMV? That's what government run anything will look like here. :'(
Can't we have a system like the Canadian system but with the added option that if you don't want to wait, you can pay full price to have the surgery now, just like in America?
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Re: Gold's Time To Shine?

Post by D1984 » Sun Feb 16, 2020 3:40 am

blackomen wrote:
Sat Feb 15, 2020 1:12 pm
MangoMan wrote:
Fri Jan 31, 2020 7:22 am
vnatale wrote:
Thu Jan 30, 2020 10:43 pm
Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
IDK about you, but I have lots of friends that have had various joints replaced, and from what I hear, you don't want the government deciding how much pain you are in or how you should walk 20 yards without a cane. I'd rather do the surgery when *I* think it's time, not some lackey with zero medical background. Ever been to the DMV? That's what government run anything will look like here. :'(
Can't we have a system like the Canadian system but with the added option that if you don't want to wait, you can pay full price to have the surgery now, just like in America?
AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
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Re: Gold's Time To Shine?

Post by D1984 » Sun Feb 16, 2020 10:34 am

MangoMan wrote:
Sun Feb 16, 2020 8:31 am
D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.
I guess if you asked Ontario's Minister for Health he/she would say that was the whole point; they want to avoid as much as feasible a two-tiered system and by keeping as many doctors practicing in the public system as possible (and incentivizing as few of them as possible into cash-only practices) this helps to ensure that the vast majority of the wealthy use the same system everyone else does and thus have an incentive to want to see it working well just like the poor and middle class do.

Most countries with universal healthcare don't regulate what cash-only doctors can charge but EVERY country with universal healthcare does directly or indirectly regulate what providers can charge those insured under the system (whether that system is socialized medicine a la the NHS, single-payer like in Canada, single-payer with additional optional private insurance for stuff the public system doesn't fully cover like France, single-payer but with the ability for those who can afford and wish to to buy a private insurance policy and totally bypass the public system like Australia, government-funded hospitals, government catastrophic insurance and private health savings accounts like in Singapore, or a mandatory private but not-for-profit system like Switzerland where you are required/mandated to buy insurance--and subsidized if you are too poor--but can choose from a variety of not-for-profit private insurers and switch if you are unsatisfied); we alone in America do not have universal healthcare and don't do any kind of nationwide or statewide regulation of what providers can charge and thus we get ripped off by some of the highest prices for medical care in the world....see the IFHP reports if you don't believe this.
We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto socialized medicine.
If a doctor doesn't like the prices the private insurance companies offer and doesn't like what Medicare offers either he/she can just run a cash-only practice. They would likely have plenty of cash-only patients if they charged, say, from $11 to $45 for an office visit--which is the range of prices for an office visit (not copayments...actual prices in full...and this is to see a regular GP, not an NP or a PA) in other countries (again, as per the IFHP reports...granted, this is from the 2013 and 2010 reports--they issue a report every few years but not every report includes the cost of a routine office visit--so prices may be a little higher in other countries since then due to inflation....but I'd be willing to bet US prices rose just as fast if not faster). And yes, I know that to do this (have doctors charge such low prices for a basic GP office visit) we would have to be more like other countries and revamp our whole education system and have heavily subsidized (or free) college and medical education so that doctors didn't graduate med school with a $260K (or more) millstone around their necks that makes them see the need for much higher salaries than in other countries and we'd also have to start paying them decent wages during internship/residency rather than 45K or so a year (and while we're at it, also stop working them so many crazy excessive hours during said internship/residency which means we'd need to lift the Medicare MCE cap and fund training of several thousands or tens of thousands of doctors more each year so we'd actually have enough docs without overworking/burning out the ones we have during the immediate postgrad training like we do now)...all of which I'd be fine with BTW; it would cost more upfront but it would likely save money over the long term.

We don't have de facto socialized medicine; socialized medicine is when the government runs the hospitals/clinics directly and the doctors/nurses are all salaried government employees. We do have a system of quasi-price regulation by insurance companies and Medicare but Medicare cannot negotiate as low of prices as the universal systems in other countries because it is not the monopsony buyer--since it does not cover everyone but only covers the elderly and those with ESRD-- and because since private insurance exists as well (private insurance exists in plenty of other countries too but in all of those countries private insurers negotiate with providers on a nationwide/provincewide/cantonwide basis and so have some serious negotiating clout owing to the fact that in such a situation these private insurers are negotiating all as one and are thus a quasi-monopsony buyer as well) so if Medicare offers too little in the eyes of providers they can just say no and refuse Medicare and only take privately insured patients; private insurers have little/no negotiating clout here in the US because there are typically ten (or more) of them competing whereas in many/most areas providers are effectively a monopoly or an oligopoly and so the providers (hospitals/doctors/drug companies/medical device makers) can name their price and the private insurer has little choice but to take it.

If we had universal Medicare for all (or at least all-payer rate setting where all the private insurers + Medicare + Medicaid negotiated prices all as one on a national or regional basis and thus functioned as a monopsony buyer de facto even if not de jure) then the power would be back in the buyer's lap and medical prices would likely come down to be somewhat closer to the prices in the rest of the OECD countries. We don't so we get stuck with some of the highest healthcare prices in the developed world.
Last edited by D1984 on Sun Feb 16, 2020 12:17 pm, edited 1 time in total.
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