Anne, medical info. privacy is highly valued here in Canada. Does the U.S. have govn't tribunals/commissions that take in cases of medical/personal info. of unauthorized access or misuse? We have such cases where decisions are made and ..posted on their websites. Parties are named.

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Anyway, my dermatologist examined my mole on my face. She use liquid nitrogen to burn top layer off, so she could see underneath. It's benign. We talked about skin care, sun, etc. I'm ok. She examined my whole body for other possible lesions, etc.

I will not be extra-billed for this specialized doctor visit/work. There maybe other specialized procedures I could have been billed..particularily if cosmetic.

Each provincial govn't has a set list of drugs of whether or not certain drugs are covered by public medical insurance. Or the patients pays a percentage of total cost. There are also specific programs for the elderly poor, the disabled, etc.

Dental care is not covered by public medical insurance. Usually a large/good employers provide some coverage through benefits. For unemployed, you pay in full.

Psychiatric care and psychological counselling is rarely covered in full or not all by public medical care insurance. (Eagleheart perhaps you can respond here, please.) There are specialized programs but they tend to be for very poor, certain mental health conditions, etc. I found out last night after speaking with a social worker who works for 1 of the local hospitals. He is a case worker for a PILOT (so this is not even permanent) project for schizoprenics, etc.

There are some fees, though not horrendous that might apply, ie. when my partner's mother had to go by ambulance to hospital a couple of kms. away, it was $60.00. It is possible, air ambulance services there is a fee, but it's doubtful it is full cost recovery from patient.

Giving birth in hospital, to my understanding a Canadian woman is not billed directly at all. However if she needed to stay extra long in hospital there would be a fee, which some employers provide in the work benefits pkg.

Nursing home care is not all public. The best run homes that I know, do tend to be publicly funded and also such institutions are WAY more transparent in their management decision-making and best practices. Many private run homes...which in my opinion, can be a dubious scenario. (Inspection by government of such facilities for different things makes it complex to regulate/monitor.)

It shocks many Canadians that many adult Americans don't have health care. It shocked me that not all American cyclists would not have medical insurance in case of any accident, minor or traumatic.

I know of Canadian friend, whose New York state relative paid over $200,000US for medical bills for a family member who was quite ill. this is not normal for any Canadian,..unless for some reason one had a disabling accident that resulted in extensive care, purchase of equipment/retrofit of home, etc.

There is some talk about privatization...but truly I'd rather we force our current organizations to become better.

And whenever my parents visit doctor, my father had appendicitis, my mother with her drugs, etc.....their visits are paid by public medical insurance. They pay the monthly fee....and they are taxpayers.

The federal Canada Health Act is the main piece of legislation which defines the overall authorities and broad framework of our public medical care system.

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I also think that both U.S. and Canada probably share the same problem but with different manifestations,..where both are geographically large countries with uneven distribution of population. In Canada there are problems of attracting doctors to rural areas and smaller cities. Hence medical care for people living in those areas (regardless of public vs. private funds), can be a serious/time-consuming matter of travel, access, timeliness, access to medical specialists.

Hence, Germany's more compact size and compact population, makes it easier to physically delivery direct patient care.

Does U.S. have same problem?

My sister-doctor does her share ...she drives 100 kms. 1 way to her hospital (place of work) in a small city of 60,000 outside of Toronto over 3 million.

I am covered by the best medical insurance you can get. Just got back from the drug store with my prescriptions. cost $160. five years ago, with this same insurance, I would have had to pay $30.00. OUCH

This is so sad. Why would our elected officials vote against things that are good for us, for our country, for our children, for the WORLD?

This might answer that question, and it makes me sick:

Republicans are "rooting against" the U.S. and the world by way of their votes against climate change legislation, the economic stimulus, and healthcare reform bills, Rep. Henry Waxman (D-Calif.) asserted Monday.

"They want to play politics and see if they can keep any achievements from being accomplished, for fear they might become beneficial to the Democrats," said Waxman, one of the principal authors of the climate change legislation passed by the House on Friday, on MSNBC.

"So they're rooting against the country," Waxman added. "And I think in this case they're even rooting against the world, because the world needs to get its act together to stop global warming. I wish they were playing a more constructive role."

Waxman said that his climate change legislation would have to "defy conventional wisdom" in the Senate, where many observers have said it would have trouble attracting enough Republicans and centrist Democrats to survive a filibuster.

"I think we have to defy conventional wisdom and move this important legislation forward," the chairman of the Energy and Commerce Committee said. "It's going to help us become more energy independent, and that's important for our national security."

In Massachusetts, where the health care plan is being looked at as a model for the nation, the AVERAGE waiting time to see your primary care physician is ONE HUNDRED DAYS. Some see doctors right away if they go to the ER, which clogs up the waiting time for those needing acute care.

As an Independent voter, I do not have a political horse in this race to sign a basically blank health care bill. Like I said, I'm a nurse who practiced for decades and who wants real change in the health care system, not change in which politicians define health care for me and my family.

We can all tell stories of good and bad health care. I myself could write a book. But the biggest story of all is yet to come. I pray decent people prevail before it is too late.

http://www.boston.com/bostonglobe/editor..._is_failing_us/

I agree, why do they feel like they have to vote on a BLANK bill? THAT is CRAZY!
about massachusetts:
Massachusetts now has the country’s lowest percentage of the uninsured — 2.6 percent, compared with a national average of 15 percent. The folks with the long waits are the people who would not have health care at all in most states.

and here's some info about Canadian healthcare:

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S. Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it. While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

I agree on Canadian doctors tending to live and practice in urban areas which creates an imbalance /medical services shortage in more rural areas. I know how my friends who live in rural areas or just much smaller cities, have to deal with problem of lack of doctor specialists and just need for more family doctors. Josie there are nursing jobs in the Arctic..you would get a real experience serving the Inuit and folks up there! (We can complain all we want down here in southern Canada about our problems. But can't compare. Imagine being a beaten woman living in tiny town in middle of ARctic tundra with NO roads. Travel is by skidoo or plane. How would one escape?)



It gets tiring to hear outsiders talk about Canada's "socialist" (or even more laughable, communist??? People have no idea w unless they have family members who lived in a true communist regime elsewhere in the world) system and our taxation. We do have a right leaning federal govn't in power right now anyway. We do funnel our taxes to many programs which people suddenly realize that they took something for granted when they move to live overseas. Hey, alot of retired Canadians, the snowbirds who live in the U.S. for 6 months, come BACK to Canada every year to live here for several months when it's warmer. Well duh, they want the benefits of our health care system. Yes, I know of some Canadians who rushed back to Canada when they had a medical problem.



True a Canadian doctor is self-employed. They are not govn't employees. My sister-doctor reminds me of what she must do for hiring her accountant, paying for medical malpractice insurance, etc. Yes, their medical decisions is genuinely professionally independent to determine nature and level of patient care and not held under restrictions of a private instution, ie. HMO. Try to remember that they are rigorously subjected to professional disciplinary measures of the national physician licensing body plus the real probability of lawsuit just like U.S. doctors ...these 2 things alone force them to exercise reasonably good judgement. What they do have to pay attention to is a regulated list certain drugs and medical treatments that are covered under medical insurance vs. private....but they will tell the patient at the beginning before patient has to buy the drug(s) or receives treatement.




If it's not urgent, then there are waits. The parent with sniffling child will have to wait over someone who has an heart attack/car accident, a pregnant woman in labour or just broke their leg. That's reality.

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The exception would be extended health care not covered by medical insurance, but if one has a work benefit or purchased via Blue Cross or another private insurer, then one submits a claim to such company. Usually it services and treatments beyond the core services for all Canadian residents. For instance physiotherapy, podiatric, psychological counselling, etc. work or staying at a hospital longer, etc. But yes, the Canadian doctors work on fee-for -service basis..and there's no distinction if they serve a high income or low income patient. They are reimbursed at the same rate from the govn't.

I don't entirely agree about the regional health authorities and boards. The regional health authorities are funded primarily by public funds from home province. There is fundraising done by various hospitals..but that's no different from the U.S., I suspect. Canada just doesn't have alot of rich philanthropists compared to the U.S.

As a taxpayer of several decades now, I feel no guilt that I am using medical services abit more frequently now. I'm making up for unused services in past. When I was younger I went for several years with no need to see any health care provider but my tax dollars were supporting the health care system...which benefits my low-income parents, etc. I'm so grateful folks like them, do receive quality care.

I am certain the U.S. and Canada share the same problem of centralized national patient care records system and the need for one. Anyone care to answer this?

yes, you're right, Orchid, there's a big fight right now. If they computerize and centralize medical records, is the arguement, will that make us vulnerable to medical records / identity theft? So a lot of Americans are fighting against this.

I had a very close friend well for 20 years which I chose to break apart 13 years ago. We were buddies since middle school onward. She is in a middle management position with GlaxoSmithKline and has been there for the whole of her career so far. (So she has no other exposures to health care organizations outside of private sector.)

I broke this friendship over several things, but a large one was the attitude I witnessed which she was passionate in her case for the pharmaceutical giants and their need for profits for corporate sustainability. Why Canada needed HMOs. It horrified me because this a someone I knew who knew our poor my family was, knew my parents personally and their financial struggles.

It really angered me, that a university educated friend with a Master's degree in Pharmacology,...was so blind to social economic reality. HOw much she sunk in my opinion, for the corporate mantra. My counter arguments were from what I knew hearing from 2 pharmacist sisters who gave me the lowdown on what pharamas do to block generic drug competition, sales marketing to doctors and future pharmacy students, etc.

Edelweiss...you're so right...I don't know why some Americans are so afraid of what President Obama is trying to do here. I realize that change is hard, but continuing to keep our heads in the sand, allowing the drug companies to run this country, rob the citizens of this country while they get rich is mind boggling to me. Wake up America...we've got it wrong. No system is perfect, but we need to stop allowing the drug companies and hospitals bankrupt us...look how much it costs after retirement...my MIL can barely afford her meds or her insurance costs.

I just read this, thought you guys would like to see it too:
http://cotocrew.wordpress.com/2009/06/30/a-look-at-the-venezuelan-healthcare-system/

During my time in Venezuela, I developed a cough that went on for three weeks and progressively worsened. Finally, after I had become incredibly congested and developed a fever, I decided to attend a Barrio Adentro clinic. The closest one available was a Barrio Adentro II Centro de Diagonostico Integral (CDI) and I headed in without my medical records or calling to make an appointment. Immediately, I was ushered into a small room where Carmen, a friendly Cuban doctor, began questioning me about my symptoms. She listened to my lungs and walked me over to another examination room where, again without waiting, I had x-rays taken. Afterwards, the technician walked me to a chair and apologized profusely that I had to wait for the x-rays to be developed, promising that it would take no more than five minutes. Sure enough, five minutes later he returned with both x-rays developed. Carmen studied the x-rays and informed me that I had pneumonia, showing me the telltale shadows. She sent me away with my x-rays, three medications to treat my pneumonia, congestion, and fever, and made me promise to come back if my conditioned failed to improve or worsened within three days.

I walked out of the clinic with a diagnosis and treatment within twenty-five minutes of entering, without paying a dime. There was no wait, no paperwork, and no questions about my ability to pay, my nationality, or whether, as a foreigner, I was entitled to free comprehensive health care. There was no monetary value connected with my physical well-being; the care I received was not contingent upon my ability to pay. I was treated with dignity, respect, and compassion, my illness was cured and I was able to continue with my journey in Venezuela.

This past year, a family friend was not so lucky. At the age of 56, she was going back to school and was uninsured. She came down with what she thought was a severe case of the flu, and as her condition worsened she decided not to see a doctor because of the cost. She died at home in bed, losing her life to a system that did not respect her basic human right to survive. Her death is not an isolated incident. Over 18,000 United States residents die every year because of their lack of prohibitively expensive health insurance. The United States has the distinct honor of being the “only wealthy industrialized nation that does not ensure that all citizens have coverage”.(8) Instead, we have commodified the public health and well being of those live in the US, leaving them on their own to obtain insurance. Those whose jobs do not provide insurance, can’t get enough hours to qualify for health care coverage through their workplace, are unemployed, or have “previously existing conditions” that exclude them from coverage are forced to choose between the potentially fatal decision of refusing medical care and accumulating medical bills that trap them in an inescapable cycle of debt. And sometimes, that decision is made for them. Doctors often ask that dreaded question; “do you have insurance?” before scheduling critical tests, procedures, or treatments. When the answer is no, treatments that were deemed necessary before are suddenly canceled as the ability to pay becomes more important than the patient’s health.(9)

It is estimated that there are over fifty million United States residents currently living without health insurance, a number that will skyrocket as unemployment rates increase and people lose their work-based health care coverage in this time of international financial crisis.(10) Already this year, 7.5 million people have lost work-related coverage. Budget cuts for the state of Washington this year will remove over forty thousand people from Washington Basic Health, a subsidized program which already has a waiting list of seventeen thousand people.(11) As I returned to the US from Venezuela, I was faced with the realization that as a society, the United States places a monetary value on life. That we make life and death judgments based on an individual’s ability to pay. And that someone with the same condition I had recently recovered from had died because, according to our system, her life wasn’t insured.