Heartbreaking!!! CanadaCare sends baby to US!

[Looking2BGSinOR]

Deb...see my ex doesn't understand or care about the fact that he could be faced with THOUSANDS in bills tomorrow. I used to think the same way when none of us had insurance (the kids included). I was pregnant with our second and ended up in the hospital for 5 days due to anemia and had just got out of the military. I was pregnant so no one would insure me. My ex was against state health care so we went without. That was until we got a $10k hospital bill. He agreed to let me apply for state care and so it went until the baby was born and we got off of it. I had to get high risk health insurance after that due to my headaches. I was a SAHM and he worked for a friend under the table so we didn't have the option of company health insurance. We couldn't afford to insure the 2 kids under the high risk plan. So I applied for the 2 kids to get normal insurance and my son was denied due to a pilondial cyst... To have them insured under my high risk plan would have been $700+ a month. So it turns out I didn't get them insurance until I separated from the ex and got a job that offered it. It wasn't cheap but it wasn't no $700 a month.

Now that DS is having bowel issues I'm thankful for health insurance. All that money I paid in is being used now. We'll be meeting his $3500 out of pocket maxium this year since he's had 2 surgeries and is being referred to a teaching hospital 5 hours away... I understand the need for insurance but others do not and some just don't care (like the ex).

Then there is the gamet of those who can't afford it and have gone to the dr. and couldn't pay the bills and those go to collections. THe doctors not getting paid for their services are part of the reason why medical costs keep rising as well. It's a vicious circle.

[Kakaji]

I feel for you Kari. I believe that is a chunk of the plan that is intended to bring the costs down for everyone. If someone just doesn't get it, they can't choose to walk around without it. Like if someone doesn't get car insurance, they still effect us all if they don't get it... so we force them to get it.

Also, the cost of all those people that couldn't get it because of preexisting conditions or marginal incomes costs us all money. When my BIL went to the hospital and had heart surgery without insurance because he ran a small business he had an astronomical bill. He sold his business and declared bankruptcy. The hospitals and doctors ate the bills and wrote them off (less tax money paid in) and now there is one less business in the community to offer competition and employ a few people.

I am not saying that whatever they come up with will be an answer to everything, but geeze, we ought to be able to do better than we are doing now for more people... whatever the reason they don't have it.

[Looking2BGSinOR]

There will always be someone not happy though. You have those with standardized health care not happy. You have those with private health care not happy. People complain and moan because insurance won't pay for this or that..and I believe they shouldn't pay for every little thing. Here in Oregon the state health care was being abused. People went to the ER for colds, things that they could see their GP for...so the state required a copay of $3 for emergency room visits and people got up in arms. Now there is that copay for most services. And I bet that most who threw a fit didn't give up their sodas. booze, drugs or cigarettes to afford it..they just complained. There is too much abuse of the system meant to help people and yep it affects everyone... I wish people could see that.

[HeidiRoo]

Originally Posted by Looking2BGSinOR

There will always be someone not happy though. You have those with standardized health care not happy. You have those with private health care not happy. People complain and moan because insurance won't pay for this or that..and I believe they shouldn't pay for every little thing. Here in Oregon the state health care was being abused. People went to the ER for colds, things that they could see their GP for...so the state required a copay of sorts of a small amount (under $20) for emergency room visits and people got up in arms. But the amount of visits to the ER went down. There is too much abuse of the system meant to help people and yep it affects everyone... I wish people could see that.

Education and preventative health, two of the most important things in standardized health care systems.

[Looking2BGSinOR]

Education period is essential even with private insurance. I had people who call and ask me why they have an ER bill when they paid their $100 copay. They don't understand that the $100 is just for the ER to see them..thats not counting what care they receive or the dr. that sees them, or the tests that are ran. I tell people, if they are not dying, to go to urgent care. Because if they have a normal $20 or $40 copay for dr. visit, that is all they pay when they go to urgent care. Not to mention urgent care charges about 1/4 of what an ER charges for the same services. So they save themselves sometimes hundreds of dollars by doing urgent care and they save the insurance company as well. Less paid out for the same services.

[SillyPutty]

There are so many excellent points made here. I agree with much of what has been said and just can't resist chiming in again.

Fundamentally there are two primary options to fund a universal healthcare plan. Canada gives hospitals a budget and any patient they treat takes funding out of the budget. Therefore there is a requirement to routinely limit or deny care to ensure they can fund for the masses. As a result, the more expensive and typically critical treatments are harder to obtain without a serious fight and patient advocacy. Diagnostics are also very limited as Nicole described, which is a serious failure which costs lives.

The NHS model pays per patient treated which is far superior in terms of care but is essentially uncapped and often abused. There is no quick fix, and there are serious issues with both types of funding. Where is the balance between providing care and avoiding bankruptcy? The US cannot afford an uncapped model in the current economic climate and with the current debt load.

I know that many Americans are dissatisfied with the healthcare there, but if my child had a potentially fatal illness, I don't even have the option of going bankrupt to save their lies by providing treatment at my own cost in my own country. I couldn't relocate my entire family to the US and even families with the means to pay for service here lose loved ones to the lack of diagnostics and treatment. I won't say it doesn't happen in the US but it is frighteningly common up here.

No easy fixed, although I personally feel that user fees ($10 for ER visits, $5 for DR visits or something like that) along with education would go a long way. Unfortunately our issues are compounded by a critical shortage of doctors here so many go without a family doctor and rely on ERs for their simple medical needs, colds, flu, etc.

[Kakaji]

Originally Posted by SillyPutty

I know that many Americans are dissatisfied with the healthcare there, but if my child had a potentially fatal illness, I don't even have the option of going bankrupt to save their lies by providing treatment at my own cost in my own country. I couldn't relocate my entire family to the US and even families with the means to pay for service here lose loved ones to the lack of diagnostics and treatment. I won't say it doesn't happen in the US but it is frighteningly common up here.

Please don't think that anyone that doesn't have insurance gets great treatment. Atlanta's inner city hospital has been struggling to stay afloat. That would be where anyone without insurance would be shipped to in that region. I don't know first hand, but I have heard some real horror stories. Also, don't think that doctors will accept new patients without insurance or even with Medicaid (in my state) for the poor.

Also, if my BIL had insurance maybe he would have taken medications and had annual physicals and could have avoided the heart attack all together. Neither him nor my brother have had any health or dental insurance for the last 10 years, I doubt that they have had anything other than abysmal health care in that time period. I believe in your country they would have had at least the routine treatments that they didn't get here.

And your right that you couldn't just relocate here and just buy insurance if someone had a condition already. You would have to do all that before anyone was diagnosed with something or they are just rejected from the private insurance and wouldn't be eligible for government assistance until you have been here for xx years. We can't bring John's dad here from another country because we couldn't afford to pay for elder medical care without any insurance available to him. In order to save his life, we would probably loose everything we have worked for the last 10 years.

Just to add, that I stayed at the same job for 10 years just for the insurance. I was hired with 12 people, they were all gone within 12 months because of the bizarre treatment and low pay rate for the industry. If it wasn't that I needed insurance for infertility, I would have been gone too. How does that support a capitalistic country? I can't change jobs or start my own business for fear of my families health and my BIL looses his business because of a heart attack. Whatever we can do as a society to make sure people are healthy, productive, have resources, and flexibility are the things that fuel a capitalistic country... not allowing private industry to make huge profits off the necessities in life... like access to the best doctor.

[Looking2BGSinOR]

Something a lot of people don't know is that almost every state in the US has a high risk insurance pool. Meaning that it's a program the state put into place but isn't state aid. They put the program into place basically for anyone who CAN afford health insurance but has a condition that gets them denied by regular insurance (pregnancy, diabetes, etc). They find an insurance company willing to take it on (Oregon uses Blue Cross) and that company then figures out the rates and pays the bills, etc. The premiums are higher than traditional health insurance but not by a whole lot..meaning it's not 2x as expensive for the same type of policy..more like it costs 25-30% more on average. BUT if it means having insurance for your condition it's worth it.

[SillyPutty]

Deb, I agree but what I am saying is that if one of your children needed cancer treatment (God forbid) you could sell your house or liquidate your assets if you chose to or needed to. We don't even have that option. I bet every parent here would go bankrupt to save their child if that was what it would take to save them. It doesn't mean it's the ideal system but too many lives are lost here to inadequate health care.

And while we have universal health care, our shortage of doctors means that many millions of people like your BIL don't have access to preventative health care and end up having fatal heart attacks etc. that could have been prevented if they were able to have preventative health care.

Honestly, I don't think either system works well, but I would prefer to have the option of health insurance beyond what is available here and would happily pay for it.

[Kakaji]

Originally Posted by SillyPutty

Deb, I agree but what I am saying is that if one of your children needed cancer treatment (God forbid) you could sell your house or liquidate your assets if you chose to or needed to. We don't even have that option. I bet every parent here would go bankrupt to save their child if that was what it would take to save them. It doesn't mean it's the ideal system but too many lives are lost here to inadequate health care.

And while we have universal health care, our shortage of doctors means that many millions of people like your BIL don't have access to preventative health care and end up having fatal heart attacks etc. that could have been prevented if they were able to have preventative health care.

Honestly, I don't think either system works well, but I would prefer to have the option of health insurance beyond what is available here and would happily pay for it.

I hear ya, but it really isn't like that. I could liquidate my assets and still not have enough for cancer care. Besides, the problem with assets that aren't liquid is

1. If you need them sold immediately, you loose a lot of money. I am not complaining about the loss of money, but it wouldn't then raise enough.
2. Most American assests are mostly owned by a bank, I could sell my house for full value and get 30,000 maybe... won't go far here
3. Then you have a crashed market... you do the math

Bankruptcy really doesn't help anyone, the bank doesn't want my house, I won't get enough I really just get out of paying all my debts and loose my assests, the hospital and doctors loose because I legally get out of paying them. Frequently by the time someone gets to that situation they are renters with no or little assests.

I am not trying to say your situation is better or worse, cause that is not the direction that the politicians are going. They seem to be trying to create both options, private along side of enforced insurance and government offering. I don't fool myself for a moment that it will be perfect. I wrote computer programs for a Medicaid system for 10 years. I get the problems with government and business. It just seems like doing nothing is flippin suicide.

[SillyPutty]

Deb, I agree that bankruptcy is not the answer... My point is that with all the flaws of the US system at least you have options.

It doesn't matter how hard I work to provide for my family, I have NO choice if faced with a critical illness and there is a very real possibilty that our system would fail us.

It's not about how easy it is to liquidate assets or pull equity out of homes (a whole other debate really) but that Canadians lack the options and access to life saving diagnostics and treatments that are MORE widely available in the US, even if not universally so.

I would welcome a hybrid of the two which I hope is where the US is headed. The option to have private insurance and universal or mandated coverage for all.

It's more about the options and the ability to receive care. And without access to family doctors, our hospitals are overburdened. Our financial model encourages hospitals to severely limit care. Wait times kill people. Treatments aren't funded and even when the option exists to receive care elsewhere it is not possible.

I have toured some of the public hospitals in the US for my work and I know there are serious flaws there as well. No system is perfect but we lose more patients due to delays and lack of treatment than ANY developed nation, even though our healthcare system is touted as "free" and "available to all".

I seriously have a love/hate relationship with my career because I see the casualties of our system in very real ways. I can't understand how some can be so proud of our healthcare system with all that I see on a daily basis. The only thing we excel at is palliative care which we would need far less of if our system wasn't so flawed.

Sorry, off my soap box.

[HeidiRoo]

SP, we have the SAME things here, we're just billed differently. We pay alot more for what is essentially the same services! Personally, I'd rather the tax hike, and I paid $16,000 in taxes last year!

Your insurance can deny you care. Your insurance can make the determination whether a treatment is necessary. People here face the same things, and I'd probably say on a greater level than you guys do. Heck, the only place in this country that you can get guaranteed treatment for whatever ails you is PRISON!

[Looking2BGSinOR]

Originally Posted by HeidiRoo

SP, we have the SAME things here, we're just billed differently. We pay alot more for what is essentially the same services! Personally, I'd rather the tax hike, and I paid $16,000 in taxes last year!

Your insurance can deny you care. Your insurance can make the determination whether a treatment is necessary. People here face the same things, and I'd probably say on a greater level than you guys do. Heck, the only place in this country that you can get guaranteed treatment for whatever ails you is PRISON!

But insurance does not routinely deny LIFE SAVING treatments, such as chemo, radiation, etc. UNLESS it's something that is still deemed experimental or investigational by the FDA...then it routinely is not covered.

I've heard the gamet of pissed off people when they realize insurance didn't pay for something or wondering why insurance paid how they did. Did you know that if you have a mole removed, skin tag removed or ingrown toenail removed it's a surgery?? I'm not kidding. Doctors put the definition of surgery as "anything taken from or put into the body"..and so people go...I had a dr. visit and why wasn't it covered under the $20 copay?? Because that copay is for the doctor to diagnose you..anything above that they will bill you for and they billed you for a surgery and we paid benefits accordingly... Or the "why won't you agree to pay for my X or X"... well um those are not medically necessary. If insurance paid for whatever we wanted done no matter if it's cosmetic, investigational, experimental or what not costs for premiums would be sooo much higher than they are.

[SillyPutty]

Heidi, I hear you, but again it's about the options.

You guys choose your insurance, have choices. We have no options. None. Nada. Zip.

I couldn't opt to pay for the care. It doesn't exist. No options.

[SillyPutty]

Damn, too late to add to my post. Trying to do five things at once.

Not only do you not routinely get denied life saving treatments, but diagnostics are not witheld.

In addition, there are a number of avenues open to appeals in the event that you may require experimental treatment or are denied coverage. And you might not be COVERED but could still get the treatments if you opt for user-pay. Again, you have options.

Part of it comes down to the differences in how litigious the US is. You want to sue a doctor or hospital in Canada? Hahahahahahahahaha! Good luck with that. The doctor cost a life? Pretty much the cost of doing business.

You want to appeal for faster diagnostics? Life saving treatment? Who are you going to go to? The people who manage the flawed system and have a vested interest in protecting it as is.

We don't have appeals the way you do or state legislation that mandates insurance companies. No, your system is not perfect but there are options and SOME safeguards built in.

Like I have said before, both are flawed. It scares me when people hold our free system up as the example. And your taxes??? I would give my right arm to only have paid 16k last year. I would be able to buy a whole lot of gold standard health insurance for the difference in taxes if I lived in the US. Heck, insurance for my neighbours too. If the system was effective I would happily pay through the nose but as it is now I would feel far safer having the option. (There it is again!)

[Kakaji]

Originally Posted by SillyPutty

Heidi, I hear you, but again it's about the options.

You guys choose your insurance, have choices. We have no options. None. Nada. Zip.

I couldn't opt to pay for the care. It doesn't exist. No options.

I think you understand some of our system, but not the reality for the majority. I mean you can say you have options, but if you really don't have affordable options, they really aren't options are they. Ya know, living in the bush we made 300 dollars a month (combined income), but we were rich because those around us lived on much less. It is relative like that. It is really bad to live in a country where the resources exist but you don't have access to them. If you say that my BIL having to go to one of the worst hospitals in the country because he didn't have insurance, but somehow he had options... what if he died because of equipment that failed or unsterilized tools or that only the lower echelons of the health care industry dare worked there? It is about everyone having access to decent medical care too.

Originally Posted by Looking2BGSinOR

If insurance paid for whatever we wanted done no matter if it's cosmetic, investigational, experimental or what not costs for premiums would be sooo much higher than they are.

You ought not of said those words around me
I was told in a brochure of my insurance company that they covered infertility. I chose that company and paid for two years. Then when I called before making an appointment I was told... that is a brochure and not a contract so they didn't have an obligation to pay for infertility. I called my state's regulatory board and they told me that insurance companies don't have to pay for cosmetic surgery! Cosmetic surgery!!!! The Supreme Court ruled that infertility is a disability, but Georgia can say it is just cosmetic surgery. As for experimental treatments... what the heck? Who really decides this? I was told that IVF was experimental so they didn't have to pay too.

Let's really be honest here. An insurance company is a company not a humanity business. If they choose to support me having children then they pay out way more. It is sooooo financially beneficial for them to deny me any possible way to have kids it is not funny. Please do not hold up private insurance as any kind of anything other than a company to make profits off people... period. Ethics and profits rarely meet in a board room as our current economic situation emphasizes.
One huge problem is that states are left to regulate insurance companies and most states do a really crappy job of it. I would love to know how much an average insurance company pays out in lobbyists and politicians each year... oh don't get me started.

Nothing against you or anyone else that works in the industry unless you sit on the boards, you are a lobbyist or work in the regulation arena.

[SillyPutty]

No disrespect, Deb, but I think you and I are defining options differently.

You may not like your options and maybe they could be better but they still exist. You can choose your insurance company, you can stay in a job for the superior benefits. You could have moved to a state with laws more favorable to infertility coverage if that's what you chose. Infertility coverage is not provided here either and there is no policy you could buy to obtain it (some group plans will cover meds but not treatment). It's not like I can go get a mole removed, an eye exam or a plantars wart removed - I would pay full pop for those.

But your BIL is alive and while he might not have liked his options, he had them.

I would get a second job or sell my car and take the bus or downsize my house or whatever I had to do to ensure I could meet the needs of my family. In the US you have the option of doing that should you choose that healthcare is a neccessity. I can work my fingers to the bone to try and protect my family and it wouldn't mean squat if we were denied treatments or had delayed diagnostics. It wouldn't matter if I was prepared to sell my cars, house or soul.

I am not saying your options are ideal, but they exist. Try and put yourself in the position of having NO options and take the finances OUT of the picture.

I know that income is relative, and I get COL variances. The ABILITY to pay is a separate debate and I'm not much of a socialist. I do get that there are real financial implications to the healthcare issues, but I am pointing out the real differences in availability, options and basic system structure.
I still feel that there should be a minimum mandated standard of care, but allowing the option of private insurance would take much of the burden off of the public system and vastly improve their ability to provide services and care, reduce wait times, improve access to timely diagnostics and reduce the number of deaths due to the system failures.

[Kakaji]

Believe it or not I am all debated out! LOL... after this... LOL

It isn't socialism to have affordable health care. Anyone could loose their job tomorrow and they would loose their health care unless they had a huge nest egg. That doesn't make sense. You can't call paying for your own health needs without insurance an option if the prices they charge uninsured people are just completely insane. If you get a condition while you are out of work, you are really messed up because then once you get a job and have available insurance they can turn you down. It is a numbers game as much if not more than choices. To say that you can just move doesn't always make sense in a million ways. I suppose you had a choice too... you could have applied for American citizenship, I have friends here from Toronto.

I am not talking about socialism, I am talking about creating a system that enables people to be productive and start small businesses without huge health burdens. Those are important in a strong capitalist economy as much as anything else. I am not saying that everyone will have the same standards, I realize that, but look at American's health and medical stats compared to other industrialized countries. We are very far behind from allowing private companies and their stock holders to take advantage of people's needs with very little regulation.

[Kakaji]

Here ya go



Yep... 150 million dollars paid to lobbyist by insurance companies last year. For them to pay that much it has to make sense financially. What was that 150,000,000 dollars for do ya think? Maybe it was to make sure the laws suit them and not the people they cover. Just doesn't seem like the best way to protect people's health to me.

Oh yeah, here's my source:
http://www.opensecrets.org/industrie...e=2010&ind=F09

Insurance companies paid 3x as much to lobbyists as bank companies did!

[Looking2BGSinOR]

Deb I know that a crap ton of insurance companies are making huge profits. However the one I work for is not. It is not for profit. There is no huge profits. It is the largest not for profit insurer in the northwest. A few cents on every dollar to go operating costs (salaries, etc) and the rest goes to pay doctors. The company can only have a certain amount of money in excess in its stores. If it goes above that amount they have to and WILL lower premiums until it is used up and then they refigure premiums so that there is no excess but also not a defecit. They are actually all for reforming health care and are trying to educate patients about their insurance, choices and the like. Too many people go about things blind..like my example of the ER visit when urgent care could have been used thus saving the patient and the company money. In fact the higher paid execs of the company did not take their yearly bonus because if they did, the lower people like me would not have gotten ours. So they decided to forgo it and they gave it to the ones of us who made it possible to even get a bonus for them. I've had insurance with many different carriers and even before I worked for Blue cross I truely loved the company and here is why.

I got charged $1800 for a rhogam shot by a dr. while pregnant with my youngest DD. It was billed as routine and since I was on high risk insurance it didn't have routine coverage which was fine, because I wasn't using it for that. Anyway imagine my surprise when I got that notification that it wasn't paid by blue cross. So I called them up and asked WTF and they explained the whole routine thing. I told them.."UM no it wasn't routine. It was necessary to ensure the pregnancy continue after getting an amnio". So the girl said she would call the dr. and see if they could rebill under a more appropriate code. Two weeks go by and I get a call and it's the girl telling me it was rebilled and payed and what I owe was only like $80. I was just astounded that #1 that she did what she said...#2 that it was actually taken care of and #3 that she called me back to tell me. I have never had an insurance company do that. I fought my secondary insurance through my work for them to pay her deliver because I didn't pre-auth it...You can't pre-auth in labor...sorry and besides I wasn't eligible for the insurance unitl she was born due to a life change since it wasn't open enrollment, so even better I can't pre-auth on a policy I didn't have until she was born. That was an HMO plan. HUGE difference in the 2 and how they took care of me and my medical bills. Fighting with one and not the other. And I can bet the one I had to fight with was lining all kinds of big wigs pockets.

That is my experience with health care.