jojoco, I would tell them that was their mistake and their cost.

I did. They don't feel the same way. I live in a small town and we've been with this practice for 12 years. I like having a doctor that knows all of my children and has seen them grow. My daughter moved, so she had to change anyway. I felt like they had us over a barrel. And my daughters insurance was the kind you can purchase when you go to college, it was through the school.

In Canada, health care is publicly funded (non-profit publicly administered single payer) and privately delivered (physicians, pharmacists, diagnostic testing clinics, other health care providers). The Canada Health Act stipulates that Canadians must have reasonable access to medically necessary hospital and doctor services, without impediment by financial or other barriers. When Canadians buy private health insurance, it is generally to cover prescription drug costs, which are not funded by our single-payer system unless administered in hospital, or for those over 65 or on welfare. Private insurance might also cover private hospital rooms and travel medical insurance if costs are above hospital and medical care costs in Canada. Insurance firms are also trying to sell insurance for other services to Boomers afraid of end-of-life care costs.

As said above, no system is perfect. However, when I hear of stories such as bpathome's I am greatful for the Canadian system. It seems unconscionable to have to wrangle through such a tangle of insurance and medical provider networks, and then worry about costs for basic care. I wonder how many people are not up to the challenge and suffer as a result. My DH and I both have conditions that require monitoring and testing every 3 months. In the past 5 years, he has had 3 major surgeries as has DD3, and DD2 had 2 emergency abdominal surgeries in the past year with several weeks of hospital care, all with no billing to the patients. The physician decides what treatment is required and usually the only bill the patient sees is for drug costs at home. Our choice of physician or hospital has no bearing on whether costs are covered by the single-payer.

Hi Bpathome - I do agree that the Cdn system is not perfect, it absolutely has problems and failures. Like you identified - wait times are often at the top of any list, along with lack of physicians and specialists in some Provinces, especially the rural areas. I've grumbled myself about wait times, but to be fair, I think I could say that situations that need attention RIGHT NOW seem to (rightly) get bumped to the top of the list and get the attention they need... that's probably why the rest of us end up waiting longer. My BIL noticed blood in his urine in late September a few years ago, went to his doctor for urinalysis, etc., she sent him for bloodwork and then ultrasound - on his way home from the ultrasound they called him from the hospital to come back. They did a CT scan (or MRI, I don't exactly remember now), and by the second week of December he'd had surgery to remove his kidney due to cancer. I think the cases that life-and-death need-the-attention get it.

Beyond mandatory standard coverage (preventative care, medical treatment, access to hospital, etc. which are part of the Canada Health Act and provided to all Canadians), which Province you live in can influence exactly what benefits you have. Each Province administers their own healthcare plan, within guidelines provided by the Act. Many Provinces provide some additional benefits, but every Province is different - ie: prescription drugs, dental services, etc. may be provided in some Provinces but not all. Individuals are able to purchase private insurance to cover the 'gaps'. Personally, I have Blue Cross through my workplace for vision, dental and drugs, along with 'extended healthcare' such as physiotherapy, massage therapy, etc.

As a side note, I just returned from the plastic surgeon... he looked at & we discussed several of my moles. My family doctor was right, they're not suspicious or dangerous. But they are unattractive! All told, he's going to remove 4 of them for me later this month for $287.50.

I am always angered when people bash the Canadian or English systems.

jojoco, has your DD tried magnesium oil spray (a misnomer as it isn't really oil, but mag. flakes and water) for her RLS? If not she may want to read about it. I know at least two people have gotten wonderful results with it. Helps with sleep as well. I use the spray and capsules.

smhinnb, says: "along with lack of physicians and specialists in some Provinces, especially the rural areas."

I think that is what most Americans are afraid of in going single-pay, is that, the lack of physicians would probably be a big problem for us. Americans are used to the best care around, and we may lose that if we go single-pay, which I am definitely a fan of instead of ACA for sure.

Also, I wasn't aware each Province has their own healthcare plan. That doesn't seem right either. If everyone pays, why wouldn't they get the same care as everyone else? I'm sure there is a reason I haven't thought about, but, when people talk about single-pay insurance, it sounds pretty good, until you hear the "lack of physicians, different plans for different Provinces, etc", that I've never heard of before. So, I may have just talked myself out of liking single-pay?

Unfortunately, people are motived by money, and it just makes sense to me that we aren't going to have the best, or enough doctors to accommodate Americans.

The geographic distribution of healthcare providers tends to skew to more highly populated areas, and away from remote areas. There is not much, if anything, that governments can do to force individual providers into remote areas with small populations. Rural per se is not an ideal indicator, as many "rural" people live not too distant from urban centres. While each province does administer its own single payer system, care is portable when travelling across Canada, and the plans are essentially the same at core as all must provide medically necessary hospital and physician care. If you happen to change residence from one province to another, the province you are leaving will cover your doctor and hospital costs in the new province for three months during the transition period. This means minimum hassle for the patient, as it is mandatory that you be covered at all times if you are an eligible Canadian resident.

miniscule, thank for the explanation, it makes more sense now. Thank you.

Miniscule explains it well. :) The basic, core benefits are mandated by the federal Canada Health Act and would apply to all Provinces. Provinces administer the plan, but must comply with the Act in order to receive federal funding. Anything above & beyond this core coverage is up to the individual Province (some Provinces are wealthier than others, tax rates are different all across Canada, I think a few Provinces even have user-fees for some services, etc.) . In some ways each Province has their own way of doing things, but the primary core benefits are always identical for every Canadian. Core benefits include such things as preventative care, medial treatments, access to hospitals, etc. Citizens can then purchase private coverage for any additional benefits they may prefer.

"The Canada Health Act is federal legislation that puts in place conditions by which individual provinces and territories in Canada may receive funding for health care services.

There are five main principles in the Canada Health Act:

• Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the province or territory, and their records and accounts are subject to audits.

• Comprehensiveness: All necessary health services, including hospitals, physicians and surgical dentists, must be insured.

• Universality: All insured residents are entitled to the same level of health care.

• Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province during a minimum waiting period. This also applies to residents which leave the country.

• Accessibility: All insured persons have reasonable access to health care facilities. In addition, all physicians, hospitals, etc, must be provided reasonable compensation for the services they provide."

Our "health care system" is broken beyond repair. It controls too much big money for anything/anyone to ever fix it...so it's doomed to be irreparable forever. ACA only made it much worse. It hangs on its one big claim "no one can be turned down". And what good is that claim when the premiums are so expensive that we cannot even afford it anyway. If you are fortunate to work at a good job with good benefits then you don't know what I'm talking about.

What is your premium, arkansas?

DH is from Canada. He complains about the taxes in Canada, and about the cost of US health care insurance (which, along with liability and malpractice insurance, is driving up health care costs). But I think it all comes out in the wash. It's all gotta be paid for one way or another.

I'm still irked that I can't find out how much my appointment cost. I've been on hold too many times today.

It would be well over a thousand a month for the both of us. There's no way we could afford that. OH and that's for some ridiculously high deductible. What used to be a really cheap, what was called catastrophic coverage, is now too high to afford.

I think the increases some people are protesting are from things evening out. Those of us who paid ridiculously high premiums before are now paying less because it is now being spread out more among those who had good rates before. My premium was astronomical although out of pocket was not bad. Unfortunately, that money was collected up front making the policy extremely expensive even though only irregular routine services were utilized. Now my 'rate' can get very high IF I need services due to the out of pocket expenses, but I don't prepay anymore.

"What used to be a really cheap, what was called catastrophic coverage, is now too high to afford."

I've heard this from SO many people! The old catastrophic coverage was fantastic for so many people. We used it years ago at various times and our kids used it when they were between jobs. I know too many people who are either going without or paying the $1k/mo. which is severely digging into their savings.

We still have our pre-ACA catastrophic coverage plan and I'm hoping we can keep it for as long as possible.

$95 a month for the 2 of us (ages 33 and 38) and a $5000 deductible. It even covers an annual exam for each of us (although not all the other stuff ACA mandates that we don't want).

If we were to buy ACA compliant policies, we would be paying around $1000/month for the two of us and we'd have a $6,500 deductible and $12,500 OOP. What a joke. And premiums are going up everywhere and people are being left with one option or no options. Gee, if only someone had predicted this!

"Gee, if only someone had predicted this!"

Shocking, isn't it?! Clearly the answer is to turn the whole thing over to D.C. because they're always so fiscally responsible.

Yeah, dsg, Medicare is such a famous disaster, so much worse than letting the insurance companies call the shots.

My plan was more of a joke before ACA. That people who are very well off are paying less than a hundred dollars a month - for two people??!! - while those who are not or are scraping by are being raped is outrageous and shameful. I know of others who are wealthy but pay very little also. Some are part of company plans though.

Now, if insurance companies are dropping out of Obamacare due to the ACA plans not paying them enough, how is it that they are offering people ridiculously low rates outside of it?

Those policies came in before the ACA, snookums. You couldn't get that now!

I called to pay another bill today and the person hesitated, then said "um, do you have a really high deductible?" Why, yes, we do (to keep our premiums low). "Oh, that explains why your bill is so high." Funny thing, I knew their rates when I walked in the door. My primary care physician can't tell me?

Funny how we all knew what would happen, but the know-it-alls in DC said it wouldn't.

Just to put things in perspective, in about 1985 I was an hourly worker, single with no dependents. I paid $12 a month for my employer-provided insurance. A visit to the OB/gyn, who was basically my primary, was $35. My 5-day stay in the hospital for a surgery was $2,000. Those days are looooong gone. Thanks to insurance companies.

We can't put all the blame for rising costs on insurance companies. Our abundant malpractice suits mean large malpractice premiums and an endless list of tests to be run before surgical procedures, all to avoid even the slightest suggestion of neglect or malfeasance. Plus, 30 years ago patients just expected to be put back to "good enough to get by." Today we expect to be brought back to perfect (even if we weren't perfect before).

I live in Ontario, but have family in other provinces. I'm comforted by the fact that no matter who I'm visiting outside of Ontario, if I get sick or injured and end up in an ER in another province, it won't cost me for any treatment I'm given.

I agree that non critical surgical procedures in Canada may have several months wait time, but anything considered serious is pretty quick.Two of my friends who were diagnosed with breast cancer both had their treatment begun very quickly after diagnosis. A family friend just got emergency brain surgery, by the same surgeon who also treats a wealthy celebrity here in Toronto, for the same cost...nothing.

My family's experience with non critical surgeries hasn't been too shabby. I had eye surgery to ward off possible glaucoma within 6 weeks of diagnosis. My father in law got his cataract surgery in under 3 months and my brother waited only 2 months for a rotator cuff repair surgery.

Most of our friends are also recently retired, and some are discussing other countries where they might love to spend their retirement years. But the one common stipulation we always hear is that it would have to be a country with a similar or better Health Care system as we have in Canada, especially as getting older usually entails more need for medical treatment than in our younger years.

I guess there is no 'utopian' country, with regard to the 3 major expenses most of us face, which are health care, education and taxes. According to the World Health Organization, France has the #1 rated healthcare. It also offers free or very low tuition for its citizens, so holds a top rating for education, as well. But it has Europe's highest taxes. Italy is very similar. So when it comes to the main expenses, if a country has great benefits in one area, it often has a deficit in another.

http://www.context.org/iclib/ic39/cooptalr/

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

The high cost of technology is also a big problem. No one can afford it, not even the insurance companies. It's not an efficient industry by any stretch either - all the testing or operationally.

Just to go to the vet involves an excessive lineup of diagnostics to rule out every possible thing at the outset. If there is anything at all going on, you can expect a minimum of $400 for the visit. Often that's just the beginning. There are not a lot of lawsuits going on in veterinary medicine. It's big business now.

Snookums, true that about the vet.

chibimimi, yes, malpractice suits have made it difficult to be a doctor, especially, as I understand it, for anesthesiologists and OB/gyns. My own OB moved out of state because, as he put it, he could no longer afford to be a doctor in our state and still raise his children and send them to college.

' he could no longer afford to be a doctor in our state and still raise his children and send them to college.'

I will add to that - and maintain the standard of living he likes. It is very expensive to live like that.

we talked about health insurance in my classes this week. I pointed out to them although my premiums haven't gone up much at all in my PPO, the out of pocket costs have gone up dramatically from a max of $7K per year out of pocket to over $10K out of pocket for out of network, which is my preferred hospital system. The deductible has gone up about $100. But no, with deductible, copay, and coinsurance, I have no idea what anything is going to cost often, though some doctors offices are better than others.

Snookums live like that? Like what? He was a neighbor, besides my doctor.

OB/gyns complete 4 years of med school, and an additional 4 years of residency which is low-paid and stressful work. If they want to specialize, they may have to complete an additional three year fellowship.

They spend hundreds of thousands of dollars to go to med school. They are on call terrible hours (all the time, basically, if baby delivers). And they save babies and mothers' lives, all while facing the highest malpractice insurance premiums of any field.

I think they deserve to make a very nice living. In fact, pretty much all doctors do. I think the very least valid complaint about our medical system would be that doctor salaries are too high!

bp, I don't know where you live but the doctors I have known have very expensive lifestyles. I have no problem with doctors making a lot of money considering what they do. Relative to other jobs that require a lot less, they should be making more. But to say that they wouldn't be able to afford to raise their children or send them to college when people who make far less or not that much manage to doesn't ring true.

I remember seeing numbers on malpractice insurance costs before, which weren't that high. I would guess this guy knows what he's talking about since he is a doctor:

http://www.huffingtonpost.com/david-belk/medical-malpractice-costs_b_4171189.html

Some thoughts on our health care.....it has evolved into a convoluted labyrinth that needs drastic changes. And there are serious issues with both our system and the national health care systems in other countries.

Malpractice rates vary widely by region and a lot of that is due to the particular 'culture' of the area. Philly has long been notorious for juries that reward defendants with high malpractice settlements - well actually Philly juries often give high rewards in many insurance cases.

DS represents insurers and was assigned to several asbestos settlement cases - he made the comment that in his profession it's unofficially considered legal malpractice if you don't bring your case into the Philly court system.

My Orthopedic surgeon moved his entire group to NC about 10 years ago and reports that he's much happier. It's not just that his malpractice rates are lower - so are his insurance reimbursements. But he say that he no longer sees a new patient and wonders if the patient is going to sue him. The area is just not as litigious.

DH is a medical oncologist who has treated many patients from Canada who came down for treatment because it was either not available in their home province or the wait time was too long.

My son has a high level position with TD bank and works at their US headquarters and many of his co-workers are Canadians. I specifically asked him how the bank handles their health care. He said that he cannot think of a single Canadian who hasn't commented that they love the medical care they receive here - both the quality and the short wait times. They often bring their parents down and claim they live with them so that they can receive treatment here.

My neighbor brought her mother over from the Netherlands for a heart valve replacement because she was considered beyond the optimal age and would have had an extensive wait.

DH was in favor of expanding health care but he is completely disillusioned with the ACA. While he has many complaints with Medicare he felt that in most cases it worked and he thought that expanding it was the better solution than the fractured mess we now have.

I think prices are spinning out of control so that insurers can justify costly increases swearing it's obamacare and not them, then they'll get rid of Obamacare and back to excluding pre-existing conditions and ever more unconscionable profits..

Prices started spinning out of control before the ACA.

Don't get me started on pre-existing conditions. From a business point of view, I understand their not covering them. But that they can turn you down flat because of one is unconscionable. One's pre-existing condition may have no impact or even potential impact on other aspects of one's health, yet they can still exclude you completely. It left many people without insurance at all.

Yeah and the high cost leaves us without any insurance at all, after all, you cannot squeeze blood out of a turnip!

Here is a great example of rising healthcare costs.

This wife wants a $5K work-up (3 medical visits in a week, urgent care, ED, PCP, CXR, bronchodilators, abx, steroids, blood tests, CT scan), and comments are referring her to a pulmonologist - for something (viral bronchitis) that would have been treated with a $5 bottle of OTC cough syrup in the past.

Westsider, true, I was talking about before the ACA. DH was ready to go independent in his career. When we looked into the insurance aspect, we realized that he had to stay with a company for the group insurance so a member of our family couldn't be excluded.

bp, yes, the independent/self-employed people have always gotten the shaft! A few years ago, we finally found a group policy that accepted our very small company, and even though it was pretty expensive at the time-I felt like we could afford the premium because the deductibles were $1500, AND paid for doctor visits AND prescriptions. That's why, I was "halfway" excited for ACA in the very beginning-and all the promises.

It is WAY worse on ACA for the independent/self-employed for our family. Many families (self-employed), are going without insurance because they cannot afford the premium AND the doctor visits AND prescriptions out of pocket. Because, by the time you pay the premium, you can't afford to go to the doctor because the (less expensive) insurance that someone could barely afford doesn't pay for doctor visits or any prescriptions anyway.

You just made an excellent case for single payer, government administered health insurance for all. Thank you, olliesmom!

sheesh, I've said it before-I think I'm ready for that! Unless, there are hidden things in that also that I do not totally understand. After this ACA carp-I am a little gun-shy since we weren't told everything. I know nothing is perfect, but single pay has to be much better than this. But, I do know, I am not a fan at all of insurance companies!

Not only what olliesmom said, but pre-ACA my out of pocket expenses went towards my deductible. Under my ACA plan, I have to pay $6K out of pocket before anything starts counting towards the deductible, and I have a fairly deluxe plan.

I've always been in favor of the US joining the rest of the developed world with single payer (It works fine for medicare, after all), but the insurance companies are too powerful and too rich. It will not happen in my lifetime.

Medicare isn't completely single-payer, you still have to have supplemental insurance.

the thing that still grinds my gears is that the doctor's office could not tell me how much my office visit would be. I won't know for weeks, when I receive the "this is not a bill" bill, multiple statements from insurance and doctor, and finally "this is your bill, pay up." Why couldn't I just pay as I left the office?!

Medicare isn't completely single-payer, you still have to have supplemental insurance.

True, but there's a huge difference between that and normal insurance.

Medicare is one-size-fits-all. The only way to tailor it to your individual needs is through the supplement plans from private insurers. And even that is to some extent regulated by Medicare.

Bpathmore, I have gotten costs for physicians visits directly from my insurance company. Sounds like you wanted what is considered wellness visit. Very different than an office visit. Wellness visits are routine yearly visits.

Jersey girl, the problem was that I was unexpectedly out of network, and the physical would not be covered. So they coded me as an office visit instead, did nothing but take my BP and give me refill, but still could not tell me the cost.

smhinnb, says: "along with lack of physicians and specialists in some Provinces, especially the rural areas."

Response: I think that is what most Americans are afraid of in going single-pay, is that, the lack of physicians would probably be a big problem for us. Americans are used to the best care around, and we may lose that if we go single-pay, which I am definitely a fan of instead of ACA for sure.

There is already a problem in the US finding specialists in rural areas. There has been for decades. And I'm not talking just about just pediatric cardiologists, or endocrinologists -- I'm talking about basic OB/GYN services, radiologists, etc. these underserved areas will remain underserved for some time, even under single payer. It will take a while for the new equilibrium to settle in -- new earnings expectations for physicians, etc. -- and there will definitely be growing pains. Growing pains can mean scarcities in areas that haven't experienced them before. But it wouldn't be the end of the world.