JJ5, your description of your sister's HMO bears very little resemblance to the one we use. If, in fact, her kids have deveeloped a "doctor" habit, then the fault is with your sister, not the HMO.

You are qhite correct that antibiotics have been over-prescribed in the past, but not by HMOs, by doctors. Our doctors do not prescribe antibiotics for every little thing and are reluctant to prescribe medication which is not absolutely necessary. Many parents bully their kids' doctors into prescribing something-anything-because then they fell that "something" has been done to help their child.

I'm not a big fan of HMOs myself, my ex supplies the health insurance for our kids and you can be sure he doesn't consult me! However, I think you're giving them all a bad name and blaming them for things they really aren't responsible for. I'm sorry about your brother's siuation. That type of thing is exactly why I am wary of them.

Relatively few of the lawsuits against doctors are frivolous and the cost of them is a tiny percentage of overall medical costs. My own feeling about this is that the medical profession needs to do a much better job of policing itself. And, if a doctor is not allowed to practice in one state, he/she should not be able to set up shop in any other state.

State to state it's different with the lawsuits. Believe me in IL some of them are frivolous, and they are not a small cost factor. We have a county area in Will county IL where there have been so many lawsuits in OB/GYN across the board (22 doctors, 3 hospitals) that there is no longer an OB GYN practicing in that district. Terrible for the people who live there in Minooka/Braidwood area.

They were not all bad doctors that needed to police themselves. These doctors were victims of a court system that allowed numerous sympathy lawsuits to pass to court and in the process of defending themselves, their insurance district rate becomes too much to support a practice. So many % of all live births will have some genetic disease or anomaly. It always "works" if there is someone to blame.

If anyone here has an HBO that works great for them, I'm glad for you. My friends here in IL with HMO's are ready to tear their hair out right now. They are going under like stones in a pond and then mid-treatment they are having to find another doctor in their new converted PPO or HMO systems. We have one HMO, Meyer Medical, that has 20 plus years of records that have been "lost". And another friend with a heart problem in HMO has had to have her test results "found and redelivered" to the new HMO entity for a fee. Cook and Will County people by me are deserting their HMO's in droves.

The basis of care with your primary physician is making am excellent communication and understanding of accessment with YOUR doctor. He then KNOWS what special condition or allergy etc. exists. This is just more difficult in a HMO.

And the final straw for me is that government in my state is corrupt. Both parties have fleeced the people for generations and at both city and state levels. I could not see giving them another sector to turn into cronyism.

Barbara,

I think you have read too much propoganda regarding Walmart. Note the organized labor has spent a lot of effort trying to unionize Walmart employees, and has been unsuccessful. Now they have moved into a stage of creating so much negative information about the company that they hope the company will capitulate. I know three people who work at Walmart, all part time and not provided insurance by Walmart, yet all are insured! Two are retired from other places and on Medicare; one is a stay-at-home mom who picks up some money by working while her kids are in school, but she is covered by her husband's insurance. So any "study" that just assumes that the many thousands of part time employees of Walmart lack insurance coverage is either uninformed or dishonest, or both.

Also, the idea that few lawsuits against physicians are frivolous ignores the economics of the personal injury litigation industry. There are hordes of hungry lawyers and hundreds of insurance companies involved, and almost everyone has read of cases where millions have been awarded when the injury appears to have been less serious than would warrant such a verdict. The physicians' concern is with having to take time away from his practice for deposition and trial, and with the size of his malpractice premium, which has soared, in part because of less generous returns on investments by the insurance companies, and in part because they have to recognize the possibility of an unwarrantedly large judgment. I went to high school with a girl who subsequently became an OB/GYN. She gave up her practice far before normal retirement age. Now, maybe she had made enough that she didn't need any more, but the reason she gives is the size of her insurance premium had soared, to the point where she could not make money.

I don't know how other countries handle the question of malpractice, but I'm pretty confident that if the US went to a single payer system, and that payer was the government, the government would severely limit, if not eliminate, the possibility of its having to pay any malpractice judgments. They have already limited recovery for claims arising for coverage by an employer-provided plan, such as an HMO.

Doctors who favor a universal coverage by the government should visit Russia, where your taxi driver is very possibly a physician trying to eke out a living by practicing medicine during the day and hacking at night.

I don't agree that it's all propaganda regarding Walmart. It's nice that the people you know have insurance from other sources, but why should this let Walmart off the hook? If employer-provided health insurance is the standard means of having health insurance in this country, which rightly or wrongly it is, then why does one of the nation's largest employers, which makes huge profits, not make sure that they provide it? Other companie are able toproide insurance for part time workers, why not Walmart?

But, I was interested last week to read that Walmart is considering getting into the banking business. This would make converts out of lots of people, if Walmart could get Big Bank to lower their ridiculous charges.

I didn't say there are no frivolous law suits, but we are led to believe that virtually every malpractice suit is frivolous. This is definitely not the case. I really don't recall hearing about someone being awarded millions in a malpractice suit for a relatively insignificant matter. Don't confuse malpractice suits with other personal injury things, like the hot coffee at McDonalds. Not the same thing at all. Yes, there are quite a few like that, but that is a different argument.

Let's see:
I am Canadian. Our healthcare system is funded by taxes - personal and corporate. My personal experiences have been fine. I pay nothing for surgeries, hospital stays, medical tests (x-rays, ultra-sound, bone density, colonoscopy, blood tests etc) and visits to the Dr. Of course a portion of my taxes finances the healthcare system (My personal income tax rate is about 35% - sorry off the top of my head I don't know how much of this goes to healthcare spending. Personally I have had 2 elective surgeries - neither urgent. I had to wait 2 months for the first one and 6 months for the 2nd one. I considered neither wait to be a hardship.
A friend of mine recently had to have prostate surgery. It was not urgent but he was getting more and more uncomfortable. He was told that the wait would be about 2 months but if he was prepared to take a cancellation on short notice the wait would be less. He received a cancellation call 3 weeks later and had the surgery that week. For arthroscopic surgery (at least in Canada) wait times vary depending on one's location. A friend of mine who had this done about 3 years ago waited 2 months. Another friend in a different part of the country waited less than a month. A cousin waited nearly 6 months.

"Finally, the simple fact that Canada has criminalized those that seek, at their own expense, better healthcare alternatives than those offered by the state speaks volumes about the dark side of socialized medicine."

As another poster said - this is simply NOT true. Canadians are not in any way prevented from seeking healthcare elsewhere. (And in some instances the government will pay for all or part of it). Many services are actually privately run (like the clinic I go to for my annual ultra-sound (which the government pays for)). For reasons which I can only imagine I have frequently noted people perpetrating outright lies like this. I can only assume it is just to discredit the concept of a publicly funded healthcare system. Our system is NOT perfect but outright lies about it are distasteful.

"They take antibiotics at the first sign of colds etc. These HMO's pump out antibiotics to people like a fountain. That's why most no longer work for the germs they were produced to eliminate. In fact, all American MD's give out antiobiotics way too much, because it is a pro-active billable response."

This sounds like a quote from one of the many "medical" articles in popular magazines. Our pediatrician rarely prescribes antibiotics, and only after a blood test that shows the white count at a certain level. She's unusually vigilant; many doctors prescribe on the basis of symptoms, having learned over the course of many years when they're needed. But she demands proof--and that costs the patient more money, unfortunately.

"He was "disallowed" a doctor/specialist not in his system and now has neuropathy from the herniated discs that resulted from no proper treatment in the proper time frame. He is on disability for the rest of his life, WHICH ended up being MORE expensive for all of us who pay into that system."

Not nearly enough information to take an opinion, but I will say categorically that, unless you were in the room and spoke heard the physicians and diagnoses yourself, you do not have the full story. People are notoriously unable to give clear explanations of the healthcare and recommendations they've received. I know this from people in our own family

I think there are few, if any, companies that provide health coverage for part-time employees. I know of none, and that encompasses all the places my three children worked at while going through high school and college.

It makes no sense for a company to bear the cost of coverage for a person who works part-time. It would make sense to lay off a couple of part time employees and hire a full time employee, if you are paying for coverage for all employees.

I think Walmart has a clever business plan. My understanding is that they have some full-time employees, who receive full benefits, but they also have a lot of part-time employees, who do not. There are obviously a lot of people who want to, for whatever reason, work part time, and are willing to do that for more money and fewer benefits.

I suspect that most people do not realize how expensive health coverage is to employers, and employers seem to keep this information secret (possibly they are getting a break on the price, in return for buying a large policy and keeping quiet). I know I thought the premium I was paying for my employer-provided health care was high; when I finally dug out the information about how much my employer was paying, it was three times what I was paying, this for a "cost-saving" HMO. Employers calculate the cost of an hour of labor; included in that cost are your wage, the costs of all benefits, the cost of your vacation time lost, the FICA taxes they have to pay, etc., etc. Invariably, the calculated cost of an hour of your labor is far far higher than your wage alone.

So if your part-time work cost calculated at $30, and your wage rate is $10, adding another benefit must result in a reduction in your wage rate, as your hour of work is still worth $30. I think, faced with the option of lower wages, most part time employees would opt for more money, and fewer fringes.

Yes, health care coverage is very expensive, isn't that the problem? And yes, few companies do provide benefits for part time employees, but some do. Home Depot is one. Walmart still comes up short.

I seem to recall a recent Canadian Supreme Court decision that made news even in the US. It concerned provisions of a Quebec law that forbid the private purchase of health insurance.

My argument that Canadians are unwilling to take a critical look at their healthcare system is supported by the denials in this thread of the existence of such laws.

In June this year, the Supreme Court of Canada struck down a Quebec provincial law that had made private health insurance illegal. People in other provinces may not have been aware of a Quebec law which did not affect them, only hearing about it when it was struck down by the Supremem Court. So, as there is no law in Canada forbidding private health insurance,and a quick Google search will bring up many insurance companies selling private health insurance in Canada, where is your argument now, smueller?

Saying that Canadians are not willing to take a critical look at our health care system is totally rediculous! It is one of the hottest issues in the country. Alberta is currently attempting to introduce some privately run services - with much controversy.

How to change and improve the system is a never ending debate. Some people favour a "for profit" system, like in the US, but most favour an improved, more efficient, version of the current system. The fact that most people like the non-profit, gov't supplied system, does NOT mean that they don't think there is room for improvement.

As Barbara said, the law in Quebec against basic private health insurance was STUCK DOWN. It is NOT illegal in Canada to search out alternative health care elsewhere in the world. You can travel to the US or anywhere else in the world that will let you pay for your care quite legally. What is currently not allowed, is for a surgeon to open his own surgery and to charge his patients directly, bypassing the public system (with the exception of certain procedures).

The problem with "for profit" health care is that you have to inflate costs to allow for profit. This costs more for whoever is paying - you, your insurance company or the gov't.

I have no idea what an HMO is. In Canada, each individual can select (based on if they are accepting new patients) their own "family" doctor - a general practicioner, who is their "gateway" to medical services. In order to see a specialist, you do need a referral from your own doctor. This is designed to prevent people from wasting tax $ by going to see a specialist when it isn't needed.

One thing I find very funny is the attitude towards prescription drugs in the US. Many americans who think their system is just great, come to Canada to buy their prescriptions. I have even seen prominant US politicians promoting this. Instead of promoting a trip to Canada, why not promote implementing a similar system?? It costs the Canadian gov't nothing to provide affordable prescriptions to their citizens. The gov't does not subsidise the cost of drugs, they simply regulate it. They tell the drug companies what they can charge for certain drugs. It seems that capialist ideology trumps every arguement in the US.

The arguments I made are still valid for two reasons.

1) The fact that some Canadian leaders have deemed it necessary to create laws forbidding private health insurance indicates that the universal healthcare system of Canada is in a precarious condition. Those that advocate such a system feel it is necessary to prevent Canadian citizens from witnessing the advantages offered by private healthcare coverage. Ignorance is the foundation of pride in the Canadian healthcare system.

2) Even more tellingly, the Quebec law was struck down because the Supreme Court judges in question concluded that the national healthcare system is so flawed as to contradict basic human needs outlined in the the Canadian Charter of Rights and Freedoms (sort of the Canadian equivalent of the Bill or Rights).

Americans may purchase inexpensive price-controlled prescription drugs from Canada, but how many Americans travel to Canada for treatment (surgery, diagnosis, etc.)? I suspect that this number is orders of magnitude smaller than the number of Canadians that seek treatments in the US, which has been a pressure valve for the Canadian healthcare system for the past two decades. Those wealthy enough, or desperate enough, go south for healthcare.

Smuller wrote:

"Americans may purchase inexpensive price-controlled prescription drugs from Canada, but how many Americans travel to Canada for treatment (surgery, diagnosis, etc.)?"

Well of course they wouldn't travel to Canada because they are not citizens of the country and are therefore not entitled to their services. Prescription drugs are a completely different kettle of fish; they are offered to the public for sale with a doctors' prescription. Other healthcare services---MRI's, surgeries, etc.---are NOT offered to the public for sale. That is the essence of their system: it is NOT for sale.

Nor is it free when Canadians seek treatment in the US.

But that wasn't the point under discussion.

I'm Australian, and while I'm sure our system differs in many particulars from Canada's, the basic approach is similar. Our Medicare system (not to be confused with US Medicare) provides free treatment in public hospitals for those without private insurance, and subsidised or free visits to doctors. In addition, the Pharmaceutical Benefits Scheme holds down the price of most prescription drugs to affordable levels. As a self-funded retireee I pay AU$28 (US$21) for my scripts, but if I were a social security recipient that would be less than AU$3.

Yes, there are complaints about waiting times, but I could point to my father-in-law, now in his 80s and reliant on an age pension, who's received timely and excellent treatment for a recurrent melanoma condition.

No Australian government would be brave or foolhardy enough to propose a fundamentally change to the current system - access to quality medical care is definitely considered a right, not a privilege.

Overall our health outcomes are good (with the shameful exception of our Aboriginal people), and like Europeans we spend far less per capita than does the US. The biggest failure of the current conservative government has been to throw billions at propping up the inefficient and wasteful private health insurance industry rather than investing the money in the public system. The Medicare system is part-funded by a 1.25% tax surcharge and its administration is considerably more efficient than the private insurers. The biggest single challenges are an ageing population and the escalating cost of health care.

How many americans come to Canada for health care?

Thousands.

The universality of the system has allowed countless americans living near the border to be able to get their hands on fraudulent health care cards. It is a real drain on the system.

I didn't know that, Sockboy, and sympathize with tax-paying Canadians. It's difficult to know whether to empathize with the American patient-imposters because they are desperately seeking treatment, or to villify them for their unwillingness to pay for insurance in the U.S. There are probably some of both types scamming your system.

We have our own problems with illegal immigrants who do not have access to regular and/or preventive healthcare, and who use the emergency rooms as their primary means of seeing a doctor. In a national healthcare system where everyone has a medicard id with all their vital statistics and medical history, remember the scheme Hilary Clinton tried to promote in the early 1990's?) these people would be flagged, treated for their immediate problem, and deported.

Smueller appears to be under a misapprehension vis a vis the provision of certain services under a "National Healthe Service"-type arrangement.

Quotequot;Quality of life is also important. Whether it's waiting three months versus two years for a knee replacement, or access to the MRI that reassures that a persistent vision problem is not the onset of Multiple Sclerosis, quality of life is dramatically influenced by readily available diagnosis and treatment. In addition, many US healthcare plans cover (at least partially) non-life-threatening issues that significantly impact the quality of life, such as fertility and impotence treatments, cosmetic procedures, mental health counseling, etc."

Now, I can't speak on behalf of Canadian provision but I do know for a fact that in the UK NHS and in France that "fertility and impotence treatments, cosmetic procedures, mental health counseling" are all readily available without additional cost at the point of provision.

Furthermore I personally know three individuals who have had knee replacement work - 2 in England and one in France. None of them waited anything like 2 years, indeed in one incidence the wait was just six weeks.

Maybe if people commented solely on their own experiences and the systems working in their own country (as requested by the OP) this discussion would be more factual and less clouded by the smoke of prejudice.

Chacun a son gout! as a nation We all live with the provision we (as a society) want - and that is predicated by and large by the costs we are willing to accept (whether it be in the form of taxes or insurance payments)and the belief, or otherwise, of a universal right to care.

Dr D.