Is Health Insurance Socialism?

[InfiniteNow]

A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

Himmelstein, D, E. Warren, D. Thorne, and S. Woolhander, “Illness and Injury as Contributors to Bankruptcy, “ Health Affairs Web Exclusive W5-63, 02 February , 2005.

 

 

 

NCHC | Facts About Healthcare - Health Insurance Costs

In 2008, total national health expenditures were expected to rise 6.9 percent -- two times the rate of inflation. (1) Total spending was $2.4 TRILLION in 2007, or $7900 per person (1). Total health care spending represented 17 percent of the gross domestic product (GDP).

 

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP. (1)

 

In 2008, employer health insurance premiums increased by 5.0 percent – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,700. The annual premium for single coverage averaged over $4,700. (2)

 

(1) - Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.

(2) - The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008.

[HydrogenBond]

I like the idea of the government serving two health care roles. The public sector should take over responsibility for catastrophic care. The idea is to take the highest price items and services out of the private sector insurance premium calculations. This should cause insurance premiums to fall.

 

The second thing is the government should take over the entire malpractice operation, socializing that aspect of the legal system. This will reduce cost to doctors, with the hope they will pass on the savings further lowering costs. Civil servant lawyers and judges would be cheaper, while doing the same thing.

 

The main reason the whole thing has gotten so expensive is due to the free market.

 

Let me give an analogy to the situation. Many auto manufacturers factory spec oil changes at 5000K miles. Although this is all that is needed based on objective standards, many quickie lube shops have opened, which pitch we need to change the oil every 3000 miles. How can one argue with that, since they are doing no harm. One may even argue if an auto is not maintained, it may burn oil, such that the 3000 or even 2000 mile oil change may save those cars. But it does not apply, objectively to well maintained cars.

 

It is possible that free enterprise has created the quickie lube version of medicine, convincing people they need their oil changed every 3000 miles instead of 5000 miles. It does no harm, so how can you argue.

 

Luckily, the inefficiency of the government will default back to the 5000 mile oil change for the same costs, beyond which the tax payers will get upset. Maybe once new objective data has been regenerated, the 5000 mile oil change will return. Once that mentality has been absorbed into habit, maybe the public sector can then pass the process back to the private sector for higher cost savings, due to efficiency.

[freeztar]

I can not agree. This has nothing to do with tax brackets.

 

Really?

 

They do not raise revenue as quickly as health costs rise. The plan to impose a surtax on top earners, for instance, pays a decent chunk of the bill over the next few years. But the revenue from the tax rises only as fast (roughly) as the United States economy grows. The same is true of most taxes.

 

Health costs, on the other hand, are growing much more quickly than the economy. Over the last decade, the economy has expanded by about 20 percent, and health spending has ballooned 50 percent. The gap isn’t about to start closing, either.

 

I suppose this has nothing to do with an across the board tax. Someone (some group) has to float the bill. If it ends up being 5% (or whatever %) across every income level, then I agree it has nothing to do with brackets.

 

National healthcare has to do with increasing efficiency, cutting the fat from cost of healthcare, and making healthcare available to everyone everywhere for everything they need.

 

I agree.

 

AS of 2003:

 

United Kingdom: (1) population 62 million, (2) cost $2300 per capita = public.

United States: (1) population 300 million, (3) cost $5700 per capita = private.

Snapshots: Health Care Spending in the United States and OECD Countries - Kaiser Family Foundation

 

Yet, "The U.S ranking was 24th, worse than similar industrial countries which have very high public funding of health such as Canada (ranked 5th), the UK (12th), Sweden (4th), France (3rd) and Japan (1st). But the U.S ranking was better than some other European countries such as Ireland, Denmark and Portugal which came 27th, 28th and 29th respectively. "

Socialized medicine - Wikipedia, the free encyclopedia

Thanks! :)

Morover, all those countries that ranked higher and around us have public healhtcare, spend less, and have excellent doctors; billions of people are treated. Our system simply can not stand. It is inefficent, wasteful, and fails to achieve its goals.

Aetna, Blue Cross, etc. must go out of business. We do not need them. It's wasted money. the system is cumbersome and inefficient.

We need different kinds of doctors; not the CEO looking type or a businessman, but a health professional.

 

Having been burned myself, and my credit marred for several years due to an insurance companies lack of following through on their promise, I tend to agree.

 

I do not care how they get educated, but they must be paid in accordance with the nationalized system Sweden, UK, Australia, Canada all have doctors, and they are no worse then ours.

 

No worse how? I'm quite sure specialized docs in the US make more.

Of course, the insurance companies are partially to 'blame' for this.

 

But even if the whole world had worse doctors, the price aint worth it--they are wasteful, the system is based on plans and coverages and limitations, and it costs more. It is wholly unnecessary. It is a bigger bureaucracy than anything in our government.

For the general public, I agree. For the select elite, I disagree.

 

You can tell me that increased debt is good for economy, and we depend on financial institutions such as insurance field. But this can not stand. Evidence against it is all over.

 

I've never made that claim and I don't plan to.

 

It is precisely these costs and inefficiencies that are driving us into the ground. We drowning in high costs and debt. We must change the healthcare system as a whole. There is no other way. It's the only way that makes any financial sense.

 

Funny. I feel the same way about our energy sector. ;) (nonsequiter...sorry)

 

I have no problem with reform. I just don't think we can expect to wake up tomorrow and everything be peachy. These things take time. Let it fester in Congress for a while and let's see what they can come up with, with our support.

 

I don't expect a revolution, but I do hope that we move in the right direction.

[CraigD]

It was more socialist when major health insurers were non-profits. Various lobbies (HMOs) got laws changed which basically put non-profit insurance providers out of business by requiring capital to cover expenses, prior to these law changes, the non-profits paid claims via the income received in the weekly/monthly/bi-monthly etc premium payments and kept what they needed to cover admin costs.

Having worked 25 years for a non-profit healthcare provider (not an insurance company – an actually member-funded system of clinics and hospitals, technically knows as a “staff model health maintenance organization (HMO)”), witnessing the appearance, rise, and collapse of similar systems in my service area, and experienced first hand – and, as an enterprise, survived – competition from for-profit insurance companies and their networks of doctor’s offices, clinics, and hospitals (technically known, respectively, as indemnity insurance companies and “preferred physician plans (PPOs)” or “network models”), I find this an interesting claim, Cedars.

 

Do you have source for it? Primary source references to the laws and regulations, or better, secondary source analysis and commentary on them, and their effects?

 

My observation about how large, for-profit indemnity insurance companies drove small staff and mixed model HMOs out of business is that they did it the old-fashioned, market-driven way: by under-pricing (and occasionally strategically over-pricing – more on that later) us.

 

In the 1980s and ‘90s, the market was effectively all employers offering health insurance benefits to their employees, and these employers’ decisions about which health insurers and/or providers to offer, and what if any additional cost to pass on to their employees, were usually based on a simple “go with the cheapest” rule. Because the large insurers had large cash reserves and the resources of their regionally and product diversified parent companies, they were able to reduce their premiums (monthly per-member/family price) far below the amount necessary to pay for the services they provided, and keep them there until their competition had lost too much money to survive, either by matching these unsustainably low premiums, or by not matching them, and losing the business of too many employers and their employees, who were understandably unwilling to pay more than they had to. The HMOs I know that survived this “price war” did because they had the financial backing necessary to operate at a loss while the others collapsed – in most cases, affiliation with large, well-funded medical schools and teaching hospitals, and in one case, a large, multi-state non-profit organization.

This is why way back in the good old days you didnt have the insurance companies fighting with doctors/pre-approval of services.

My second-hand personal experience with health care finance goes back to the 1960s, and I’ve a smattering of experience with history on the subject going back to the late 19th century, or arguably medieval times, and am pretty confident a “good old days” when insurers didn’t fight with providers over payment never existed, except possibly for a small population in the early days of CHAMPUS (1956 through about 1975) and Medicare (1965 through about the same).

 

Nonetheless, the popular belief in a “good old days”, somewhere around the middle of the 20th century in the US, I guess, is based in fact, though fact strongly subject to perception. It was due less to the policies of insurers, I think, than a combination of an absence of very expensive medical procedures and devices, and a difference in professional culture and ethics among US physicians and hospital administrators, manifest as a willingness to provide services for which they expected never to be paid. (there’s an long-administered entering medical student “why do you want to be an MD” survey often cited as evidence of this – I’ll try to find it and update this post with it).

The laws required the non-profits to use their income to provide the services, lower the premiums or lose their non-profit status.

While I think this is a pretty good summary of what not-for-profit (501c) legally is, it omits, I think, an important option available for non-profits to dispose of net income (AKA profits). They may use it to acquire capital goods – that is, new equipment, buildings, etc. In short, a non-profit may “burn” its profits by growing.

[InfiniteNow]

It seems the White House is getting tired of all of the misinformation. They have responded rather forcefully. Enjoy. :cup:

 

 

YouTube - The Truth About Health Care Insurance Reform http://www.youtube.com/watch?v=U0XCl6OHgiM

 

 

Here are the full videos referenced above so you can see them in context:

 

YouTube - President Obama Holds a Health Care Town Hall at AARP http://www.youtube.com/watch?v=I1wttp6VCqU

 

 

And here:

YouTube - President Obama Discusses a Public Option at his Press Conference http://www.youtube.com/watch?v=-ohjO3BW5TY

[Cedars]

Snipped argument from authority with no relevant information

(technically known, respectively, as indemnity insurance companies and “preferred physician plans (PPOs)” or “network models”), I find this an interesting claim, Cedars.

 

Do you have source for it? Primary source references to the laws and regulations, or better, secondary source analysis and commentary on them, and their effects?

My source is my aunt who quit the corporate Insurance world in the late 80s/early 90s due to the changes in structure. The changes were reward for screwing the consumer/insured out of coverage (rough generalization). She was 2nd Vice Pres at the time at a major insurer. She began working for them in the early 60s and watched as they dropped car insurance from their list of things they covered due to changes in the laws (changes affecting them), and in the 70s dropping general heath care insurance due to changes in the laws (which I imagine is this change: The Health Maintenance Organization Act of 1973 (Public Law 93-222), also known as the HMO Act of 1973, because it coincides with their companies decision). They didnt go out of business but merged with another company (whos name escapes me now) either late 90s or early 2000s.

 

HMOs vs indemnity, the costs vs benefits comes into play. Indemnity = go to the doctor when your sick (general) HMO = run to the doctor all the time and if your sick delays due to paperwork, referals, etc (general).

 

We were discussing the obama changes, which involved the discussion going into how things had changed and cause/effects of the skyrocketing prices being paid in premiums. She believes something needs to be done, but could not support Obamas plan (at the time we were discussing it) because there was not enough details for her to even begin to contemplate benefit vs cost.

 

She still works insurance, as an independent contractor, called in mostly for regional cases of food contaminations, analyzing the data to determine best approaches (settle or trial) and then administering the program to its end.

My observation about how large, for-profit indemnity insurance companies drove small staff and mixed model HMOs out of business is that they did it the old-fashioned, market-driven way: by under-pricing (and occasionally strategically over-pricing – more on that later) us.

Name two. I remember a big HMO folding in MN (dont know if it was regional or nationwide) more on that below.

In the 1980s and ‘90s, the market was effectively all employers offering health insurance benefits to their employees, and these employers’ decisions about which health insurers and/or providers to offer, and what if any additional cost to pass on to their employees, were usually based on a simple “go with the cheapest” rule.

See and I remember in 1984 when I worked for Sperry Univac (Sperry Rand) being offered the choice of an HMO or a private insurance (I think it was blue cross). Most people chose the more expensive Blue cross because of the freedom to choose. I listened to their pitch and went with the more expensive choice because of the clinics/hospitals distance from my house was more than 25 miles one way for the HMO and I had the choice of three different hosptial/clinics within 10 miles under blue cross.

Snipped irrelevant gov programs references

Nonetheless, the popular belief in a “good old days”, somewhere around the middle of the 20th century in the US, I guess, is based in fact, though fact strongly subject to perception.

Perceptions based on experience. Cant get any closer to reality than that. I know up until recently (and my only experience with HMO) my claims were paid in a timely manner and I had never received a threat of "sending you to a collection company" and I had many more choices in provider.

It was due less to the policies of insurers, I think, than a combination of an absence of very expensive medical procedures and devices,

...SNIPPING irrelevant to insurance comment....

Well this is a point which I left out of my original post. My one and only trip to urgent care (which I only went to so my boss would believe that I was ill) was a simple I dont feel good think its a virus or bug and ended up getting an MRI cuz of headache. I have to believe it was the hospital pushing for use of this 'new machine' to pay for it. There is an impact on cost due to technology.

While I think this is a pretty good summary of what not-for-profit (501c) legally is, it omits, I think, an important option available for non-profits to dispose of net income (AKA profits). They may use it to acquire capital goods – that is, new equipment, buildings, etc. In short, a non-profit may “burn” its profits by growing.

Yeah, the building the State of MN rented was formerly an HMO building "group something". Beautiful building. 9 stories tall, HUGE windows. Right on University ave just a couple blocks from the UofMN mpls. Had special florescent lights (full spectrum or something like that) which began to burn out and be replaced by new cheaper bulbs. Our plants didnt do as well under the new lights.

[Pyrotex]

I remember my insurance back in the early 1980's. It was Connecticut General (CG). It was supplied by my employers (one was McDonnell Douglas) and it was basically Total Coverage. I paid nothing to the doctors. The only charge I remember paying was 10% of the basic cost of a hospital bed (pneumonia). And that capped at $2,000. Other than that, I never received medical bills. My cost each paycheck was about 25% of the bite my current insurance takes out of my paycheck. And CG was making money!!!

 

And NOW I pay FOUR times as much (as a percentage of paycheck), I have a $15 office copay, a $20 drug copay, and I have to fork over anywhere from 5% to 25% of the costs for tests, Xrays, MRIs from a host of 3rd party medical contractors. In 1986, CG paid the full price ($6,000) for a new power wheelchair for me. Now, Blue Cross, has a $1,000/year limit on "durable appliances". An equivalent wheelchair today is at least $15,000. I would have to pay $14,000 of that. :cup:

 

If this trend continues, it is quite possible that company supplied medical insurance will be a Thing Of the Past in 10 or 20 years. And insurance will be affordable only by those pulling in 6-digit salaries. I can even see Emergency Rooms disappearing from urban areas and rural areas too poor for the average family to have insurance. There would simply be no way to pay for them.

[Cedars]

I remember my insurance back in the early 1980's. It was Connecticut General (CG). It was supplied by my employers (one was McDonnell Douglas) and it was basically Total Coverage. I paid nothing to the doctors. The only charge I remember paying was 10% of the basic cost of a hospital bed (pneumonia). And that capped at $2,000. Other than that, I never received medical bills. My cost each paycheck was about 25% of the bite my current insurance takes out of my paycheck. And CG was making money!!!

I looked up Connecticut General Seems they are under CIGNA now. I did a quick price check and for a single person between 200 and 300 per month (depending on deductable). And that was with a 1960 year of birth (not true, but what I used). They dont provide coverage in MN so I used conneticut (new haven I think was the zip).

 

And NOW I pay FOUR times as much (as a percentage of paycheck), I have a $15 office copay, a $20 drug copay, and I have to fork over anywhere from 5% to 25% of the costs for tests, Xrays, MRIs from a host of 3rd party medical contractors. In 1986, CG paid the full price ($6,000) for a new power wheelchair for me. Now, Blue Cross, has a $1,000/year limit on "durable appliances". An equivalent wheelchair today is at least $15,000. I would have to pay $14,000 of that. :cup:

Looked up wheelchairs. Invacare puts out some spendy models. $6000 in '86 was a lot of money. About what a new car cost. It was also the equivalent of 20% of the total cost of my home (bought in '84). So whos the villain? The insurance company? The wheelchair manufacturer?

 

If this trend continues, it is quite possible that company supplied medical insurance will be a Thing Of the Past in 10 or 20 years. And insurance will be affordable only by those pulling in 6-digit salaries. I can even see Emergency Rooms disappearing from urban areas and rural areas too poor for the average family to have insurance. There would simply be no way to pay for them.

 

ERs already are disappearing from those areas. Hospital mergers have done that quite well. Earlier today I was reading a 4 part article from 2005 on increasing Health care costs and they pointed out the consolidation of hospitals as a factor in increased prices. And technology.

[CraigD]

Do you have source for it? Primary source references to the laws and regulations, or better, secondary source analysis and commentary on them, and their effects?

My source is my aunt who quit the corporate Insurance world in the late 80s/early 90s due to the changes in structure.

...

(which I imagine is this change: The Health Maintenance Organization Act of 1973 (Public Law 93-222), also known as the HMO Act of 1973, because it coincides with their companies decision).

Alas, you aunt, though she sounds like a wonderful person to talk with, isn’t really an accessible source for me, or most other hypograpy readers. ;)

 

The public law info is the sort of thing I’m looking for – thanks. :hihi:

My observation about how large, for-profit indemnity insurance companies drove small staff and mixed model HMOs out of business is that they did it the old-fashioned, market-driven way: by under-pricing (and occasionally strategically over-pricing – more on that later) us

Name two.

1. Group Health Associates (of the Greater Washington, DC – the GHA acronym and name is fairly common in many areas) – after attempting to survive as a staff-model HMO, became publicly traded for-profit ca. 1990. Closed clinics about a year later, releasing its exclusively contracted physicians and mid-levels who briefly kept the GHA name.
   
2. A staff-model HMO created by Johns Hopkins University as an extension of their student/faculty/staff health organization. The latter still exists, offering some of the best healthcare in the world – if you happen to attend or work for Johns Hopkins.
   

I could name more – these are only the first couple that come to mind, because I know former clinicians and technical staff from both – though finding accounts of them on the internet would prove challenging (I can’t even find such references for hospital and clinic enterprises I’ve worked for – a lot of such information, predating about 1995, is available only in paper state records)

 

This 1999 trade journal article – 1999_07 | Staff-Model HMOs: Don't Blink or You'll Miss Them! – gives a better overview of the market presence collapse of staff-model HMOs than I can without researching and writing a serious paper (not a bad project, but likely an arduous and thankless one), though it’s dated, and, IMHO, understates the true market share of pure staff model HMO products of organizations that offer PPO and other model products because these organizations are not counted as “pure staff model HMOs”.

 

What I’d like readers to take away from all this is an appreciation of the staff HMO model, and how different it is from the models of most HMOs. The staff model essentially extends the hospital-resident physician model, requiring that clinicians practice only for the HMO, and have no role or business stake in the non-clinical part of the business, while the non-clinical part of the business have no role in the clinical part. An key principle for reducing costs is to offer only a single “everything covered” plan, as these are very easy and inexpensive to administer, but because they are uncompetitive more expensive that the market appears able to bear, AFIAK, this principle has been essentially obsolete since the mid 1990s.

[TheBigDog]

Health care costs go up as a result of improving our ability to provide care. In 1990 there were 119,000 total hip replacements in the US. In 2005 there were 235,000. That is an increase of 97% in the number of procedures performed. Any plan that covers this has seen a doubling of the associated cost for that particular procedure. If the cost of a procedure has gone down then the cost increase is something less than 97%, but the cost per procedure has gone up, not down.

 

Some procedures fall out of favor and represent a reduction of cost, but they are most often replaced with another therapy for the condition. Sometimes the new therapy is less expensive, such as antibiotics instead of ulcer surgery and tonsillectomy. Other times the new therapy is more expensive.

 

The other area of cost increase is represented by drugs like Prozac and Viagra. They created industries by providing treatments where previously there were none. This is a straight cost increase to any program that allows these treatments for its members. And each of these sparked a host of similar treatments for previously unaddressed ailments. (yes, there were predecessors to Prozac for anti-depression, but they were not nearly as widely prescribed for that condition).

 

Throw in alternative medicine; should a plan cover acupuncture, chiropractic, massage, aroma, or any other therapy that a patient may find beneficial, or should they be excluded from the plan as quackery. Who decides?

 

One last useless bit on the topic. The biggest cost to the system is ignorant usage. My youngest son got stung by a bee last Tuesday. Stung on the hand. It hurt. He cried. It got swollen locally covering about half the back of his hand (he is six, small hand). My remedy; ice and aspirin ($0.10). Soon-to-be-ex takes him to the Urgent Care Center ($50). Doctor there in what I can only imagine was an act of appeasement to the stricken mother prescribes 4 medications (four). A steroid cream, a steroid liquid (in case the topical steroid was ineffective?), an anti-histamine (in case of allergic reaction?), and an antibiotic in case the sting got infected ($40). When I pick up the prescriptions I am informed that my son is allergic to Amoxicillin (he is not) and that the antibiotic prescribed is a cousin of this; should he be taking that or is it OK? (This tidbit of idiocy comes from his having a rash a couple years earlier that did not go away with Amoxicillin, so the-soon-to-be-ex reported to the doctor that he had gotten the rash FROM the Amoxicillin so that she could get a different drug prescribed; what is the cost to the system for dancing around the truth of the matter?) So the sting was on Tuesday, and I am getting the prescriptions on Wednesday after work. When I drop them off I ask to see the kid. He is wearing gloves to play war. He is irritated complaining "How many times do I have to tell you it doesn't hurt?". There is a tiny swollen spot where the sting was, but it is pretty much gone. Now the cost to me was $90 out of pocket. This represents just a fraction of what the "system" paid for this incident.

 

Why does this happen? Because in the eyes of the-soon-to-be-ex healthcare is free, and doctors tend to over-treat to prevent being sued. Hiding the actual costs by not showing them to people breeds over-use of the system. When there is some cost involved it forces decisions to be made that ultimately control the cost. This is just one example, but how often do parents take their kid to the doctor for a bee sting because they don't know what to do? Is the treatment my kid received typical? Is it a result of appeasement, or is it a result of ***-covering; leaving no potential side effect unaddressed in an effort to prevent any possible law suite later on?

 

Every solution to the so-called health care problems fails to address all of the core issues with run away cost. If you make people pay then you are unfair to the poor and inflate costs. If you make predetermine the treatments to control the costs then you are interfering with doctors doing their jobs. And since rich people can afford to pay a doctor for non-allowed treatments you still have an issue of unfair coverage.

 

You also need to consider that the issue is wider than just "health care". Look at countries that have government supplied health coverage, look specifically at their immigration policy. To immigrate into Canada you need to speak English and have a college education. You also need to have no preexisting medical conditions that will cost more than $15,000 over five years. Why? Because they want to grow their citizenship with people who are not a burden to the system. Some excerpts from Citizenship and Immigration Canada (Immigrating to Canada)

1. According to the eligibility criteria, your application is eligible for processing if:

 

* you have an offer of arranged employment, OR

* you are a foreign national who has been living legally in Canada for one year as a temporary foreign worker or an international student, OR

* you are a skilled worker who has at least one year of experience in one or more of the occupations listed here.

 

2. If your application is eligible for processing, you must also meet the following minimum requirements to qualify as a skilled worker:

 

* you have at least one year of continuous full-time paid work experience or the equivalent in part-time continuous employment, AND

* your work experience must be Skill Type 0 (managerial occupations) or Skill Level A (professional occupations) or B (technical occupations and skilled trades) on the Canadian National Occupational Classification list, AND

* you must have had this experience within the last 10 years.

 

3. If you meet these minimum requirements, your application will then be processed according to the six selection factors in the skilled worker points grid. The six selection factors are:

 

* your education

* your abilities in English and/or French, Canada’s two official languages

* your work experience

* your age

* whether you have arranged employment in Canada, and

* your adaptability.

 

You must also show that you have enough money to support yourself and your dependants after you arrive in Canada.

You must meet these minimum requirements to apply for permanent residence under the Canadian Experience Class. You must:

 

* plan to live outside the province of Quebec

* be either:

o a temporary foreign worker with at least two years of full-time (or equivalent) skilled work experience in Canada, or

o a foreign graduate from a Canadian post-secondary institution with at least one year of full-time (or equivalent) skilled work experience in Canada

* have gained your experience in Canada with the proper work or study authorization

* apply while working in Canada – or – within one year of leaving your job in Canada

 

According to the Canadian National Occupational Classification (NOC), skilled work experience means:

 

* Skill Type 0 (managerial occupations) or

* Skill Level A (professional occupations) or

* Skill Level B (technical occupations and skilled trades)

 

Your application will be assessed on two requirements if you apply as a temporary foreign worker:

 

* your work experience and

* your ability in English or French.

 

If you apply as a graduate of a Canadian post-secondary educational institution with Canadian work experience, it will be assessed using the above requirements, as well as:

 

* your education.

 

Principal applicant

 

If you are married or living with a common-law partner in Canada, and she/he also meets the above requirements, you can decide which one of you will apply for the Canadian Experience Class as a principal applicant.

 

Note: A common-law partner is a person who has lived with you in a conjugal relationship for at least one year. Common-law partner refers to both opposite-sex and same-sex couples.

The Business Immigration Program seeks to attract experienced business people to Canada who will support the development of a strong and prosperous Canadian economy.

 

Business immigrants are expected to make a C$400,000 investment or to own and manage businesses in Canada.

 

Canada has three classes of business immigrants:

 

* investors

* entrepreneurs and

* self-employed persons.

 

Each application can be made for only one class and cannot be changed once the application is submitted. The criteria you must meet to qualify are different for each class.

And from Canada Immigration - Medical Inadmissibility

Every applicant for a Canada Immigration Visa and some applicants for temporary status in Canada are required to undergo a medical examination by a medical officer.

 

Though medical examinations are generally confined to a standard physical exam including blood and urine tests and x-rays, prior medical records as well as the applicants' mental state are examined.

 

Applicants may be denied a Canada Immigration (Permanent Resident) Visa solely on medical grounds, if:

 

* Their condition would endanger the health or safety of the Canadian population at large; or

* Their admission might cause excessive demand on existing social or health services provided by the government. *

 

 

When determining whether any person is inadmissible on medical grounds, the medical officer is obliged to consider the nature, severity or probable duration of any health impairment from which the person is suffering as well as other factors, such as:

 

* Danger of contagion;

* Unpredictable or unusual behaviour that may create a danger to public safety; and

* The supply of social or health services that the person may require in Canada and whether the use of such services will deprive Canadian nationals of these services.

 

 

* The excessive demand component is waived under the Family Sponsorship category of Canada immigration for the spouse, common-law partner, conjugal partner and dependent children of the Sponsor. The Sponsored person(s) still may be refused if their condition is considered to be a danger to Canadian public health or safety.

 

Source of dollar figures I used: http://www.smith-hughes.com/papers/pdf_bin/Overview-of-Canadian-Immigration-LawPoliciesHIV.pdf

 

The point of all this is that the more health care becomes an entitlement, or falls under government regulation, the more it leads to broader social controls. The measures taken to control the costs in Canada would not be allowed under current US policy, and would mean a gigantic change in immigration policy to keep that variable alone from running the costs out of control.

 

Bill

[Cedars]

Alas, you aunt, though she sounds like a wonderful person to talk with, isn’t really an accessible source for me, or most other hypograpy readers. ;)

 

The public law info is the sort of thing I’m looking for – thanks. :hihi:

The insider view is about all you get. Companies dont tend to post such information publicly. So you get the law info, but you dont get the effect in the boardroom and its relation to company decisions. You wont.

1. Group Health Associates (of the Greater Washington, DC – the GHA acronym and name is fairly common in many areas) – after attempting to survive as a staff-model HMO, became publicly traded for-profit ca. 1990. Closed clinics about a year later, releasing its exclusively contracted physicians and mid-levels who briefly kept the GHA name.
   
2. A staff-model HMO created by Johns Hopkins University as an extension of their student/faculty/staff health organization. The latter still exists, offering some of the best healthcare in the world – if you happen to attend or work for Johns Hopkins.
   

I could name more – these are only the first couple that come to mind, because I know former clinicians and technical staff from both – though finding accounts of them on the internet would prove challenging (I can’t even find such references for hospital and clinic enterprises I’ve worked for – a lot of such information, predating about 1995, is available only in paper state records)

 

See, this doesnt prove/disprove your original claim:

My observation about how large, for-profit indemnity insurance companies drove small staff and mixed model HMOs out of business is that they did it the old-fashioned, market-driven way: by under-pricing (and occasionally strategically over-pricing – more on that later) us.

All your response does is verify more than two that once existed, no longer do. Many small business fail within the first few years of their operations.

 

Heres one which has changed its methods/merged several times in the last 20 years:

 

RegionsHospital.com - Our History

This 1999 trade journal article – 1999_07 | Staff-Model HMOs: Don't Blink or You'll Miss Them! – gives a better overview of the market presence collapse of staff-model HMOs

From the article:

..."consumers aren't shopping for health care delivery, they're shopping for health care financing — a different ball game.

 

Two rules of that game have hit staff-model HMOs particularly hard: market demands for broad choice and great geographic accessibility. Those are hard rules to play by if your team consists of a closed panel of employed physicians and you're only located in your own few buildings."...

 

Most people are basically healthy. They dont need health care delivery they need basics for small issues (minor infections). The rest of it is all puffery (generally).

What I’d like readers to take away from all this is an appreciation of the staff HMO model, and how different it is from the models of most HMOs. The staff model essentially extends the hospital-resident physician model, requiring that clinicians practice only for the HMO, and have no role or business stake in the non-clinical part of the business, while the non-clinical part of the business have no role in the clinical part. An key principle for reducing costs is to offer only a single “everything covered” plan, as these are very easy and inexpensive to administer, but because they are uncompetitive more expensive that the market appears able to bear, AFIAK, this principle has been essentially obsolete since the mid 1990s.

And healthy young people opt out. I dont blame them a bit. $50 bucks a week (or more) for a plan I wont use until I am 40 or gonna have a family (and now its $75 - $150 a week) for dependent coverage. I used to laugh at the people who ran to their clinics on schedule for the physicals, check ups etc. More than 50% of the time, they came down sick with a bug they had picked up at the clinic. Why? Well they exposed themselves to a room full of sick people needlessly. About 20% of the time, they managed to infect someone else in the office.

 

And if they are uncompetitive and more expensive than the market is able to bear, I am unsure how anyone could come away with an appreciation of the staff HMO model.

[Cedars]

The point of all this is that the more health care becomes an entitlement, or falls under government regulation, the more it leads to broader social controls. The measures taken to control the costs in Canada would not be allowed under current US policy, and would mean a gigantic change in immigration policy to keep that variable alone from running the costs out of control.

 

Bill

 

And as far as I can tell, the push to reform health care does not reform anything. The push seems to be one direction, make it a law that everyone carries some type of policy. Throw more money at it.

 

And I dont understand why there isnt more investigation into various aspects of health care. We get reports of Medicare fraud in the millions of dollars. Mike Hatch (former Att Gen in MN) went after a handful of them and got some real changes.

 

http://images.indymedia.org/imc/twincities/text/minnesota_yqo6gn.txt

 

And yes there is the insured using their policies inappropriately feeling its 'free healthcare'. Its not. Its insurance and you dont go out and crash your car on purpose just because you have 'insurance'.

[InfiniteNow]

Health care costs go up as a result of improving our ability to provide care. In 1990 there were 119,000 total hip replacements in the US. In 2005 there were 235,000. That is an increase of 97% in the number of procedures performed. Any plan that covers this has seen a doubling of the associated cost for that particular procedure.

 

<...>

 

The other area of cost increase is represented by drugs like Prozac and Viagra. They created industries by providing treatments where previously there were none. This is a straight cost increase to any program that allows these treatments for its members.

Bill - While your argument is intuitively compelling, it simply doesn't match up with reality.

 

 

First, if our rising healthcare costs were simply a result of rising procedure costs, then the rise would be global and not limited to the US. Upon reading this, you may wish to argue that the US pays so much because it has better care and the most current technology, but as my previous references clearly demonstrate, that's simply not the case.

 

The same argument applies to your comment regarding prescription drugs... since obviously... those drugs are also available outside of the US... and those countries outside of the US have not seen the same rise in costs that we have (however, I stipulate that an argument can be made about how we in the US are paying much more for the same pharmaceuticals than other countries).

 

Finally, I'm not aware of any asymmetries in the number of "hip replacements" or other such procedures, whereby the US sees disproportionate amounts of those procedures being performed relative to other countries. If you have data that suggests otherwise, then please share it.

 

 

Either way, the heart of your argument fails. We don't pay more because we have better technology or better/more drugs, since at least 36 other nations have better care than we do, all while spending significantly less per capita. So, the rate and magnitude of cost increases we've experienced cannot be attributed to a rise in procedure costs, better technology, or new pharmaceuticals.

 

As I laid out (and thoroughly referenced) previously, the explanation is plainly a collective failure of citizens in our nation to understand that the free market can't work with healthcare coverage.

 

 

The Economic Case for Health Care Reform

Further evidence that the high level of spending in the United States reflects inefficiency comes from the behavior of spending over time. U.S. health care spending has risen dramatically in recent decades relative to spending in other countries, with no evident gains in relative outcomes. In 1970, we devoted only a moderately higher fraction of our GDP to health care than other high-income countries. As described above, today we spend dramatically more. Yet, during that period, life expectancy has actually risen less in the United States than in other countries.30 Unless one believes that other influences on life expectancy have deteriorated dramatically in the United States relative to other countries, this suggests that much of the increased U.S. spending is inefficient.

 

The inefficiencies behind the empirical estimates have been widely reported. Among the most frequently cited are:

• We spend a substantial amount on high cost, low-value treatments.
  
  
• Patients obtain too little of certain types of care that are effective and of high value.
  
  
• Patients frequently do not receive care in the most cost-effective setting.
  
  
• There is extensive variation in the quality of care provided to patients.
  
  
• There are many preventable medical errors that lead to worse outcomes and higher costs.
  
  
• Our system is complex and we have high administrative costs.
  
  

34. Wennberg, Fisher, and Skinner (2002).

 

 

 

The interested reader can find a lot of additional and useful data here:

 

The Heritage Foundation: Health Care Reform

[TheBigDog]

Bill - While your argument is intuitively compelling, it simply doesn't match up with reality.

 

 

First, if our rising healthcare costs were simply a result of rising procedure costs, then the rise would be global and not limited to the US. Upon reading this, you may wish to argue that the US pays so much because it has better care and the most current technology, but as my previous references clearly demonstrate, that's simply not the case.

 

The same argument applies to your comment regarding prescription drugs... since obviously... those drugs are also available outside of the US... and those countries outside of the US have not seen the same rise in costs that we have (however, I stipulate that an argument can be made about how we in the US are paying much more for the same pharmaceuticals than other countries).

 

Finally, I'm not aware of any asymmetries in the number of "hip replacements" or other such procedures, whereby the US sees disproportionate amounts of those procedures being performed relative to other countries. If you have data that suggests otherwise, then please share it.

 

 

Either way, the heart of your argument fails. We don't pay more because we have better technology or better/more drugs, since at least 36 other nations have better care than we do, all while spending significantly less per capita. So, the rate and magnitude of cost increases we've experienced cannot be attributed to a rise in procedure costs, better technology, or new pharmaceuticals.

 

As I laid out (and thoroughly referenced) previously, the explanation is plainly a collective failure of citizens in our nation to understand that the free market can't work with healthcare coverage.

I appreciate the response, but I did not attempt to make the argument that you credit me with failing to make. I gave examples of why costs in the US have increased, comparing them with the cost of care in other countries was not done. We pay more for a myriad of reasons. I do not claim to have listed them all, I pointed out examples of some of the reasons that our costs have risen. Simply put what I pointed out is why the costs cannot stay the same. If all other costs were a wash, the total cost of health care would still rise because of the increase in the number of treatments available, and the increased commonality of some of those treatments. That was it.

 

I went on to discuss how Canada in particular goes to lengths to control health care costs by integrating immigration requirements into health care cost controls. This demonstrates that health care cannot be kept in a bottle by itself. You must include discussion of components of policy that will impact the cost of health care. If you are going to point out a system as being effective you must include all of the reasons why it is effective. That includes in the case of Canada a restrictive immigration policy for the purpose of controlling health care costs. Is that part of the policy you would recommend in the US?

 

Bill

[InfiniteNow]

If all other costs were a wash, the total cost of health care would still rise because of the increase in the number of treatments available, and the increased commonality of some of those treatments. That was it.

I understand, but my point remains. The number of treatments has increased globally, as has the increase in commonality in those treatments, yet other nations still manage to do it better, and to provide care for all citizens, and do so all for a much lower cost per capita than we here in the US.

 

 

 

This demonstrates that health care cannot be kept in a bottle by itself. You must include discussion of components of policy that will impact the cost of health care. If you are going to point out a system as being effective you must include all of the reasons why it is effective.

I agree, which is why it's useful to study these other systems which all work.

 

 

I highly recommend this ~50 minute program from Frontline to everyone who wishes to understand how it's done in other nations.

 

FRONTLINE Video: Sick Around the World

 

Clip 1 - Great Britain: A Leader in Preventative Medicine

Clip 2 - Japan: Universal Coverage; No Gatekeepers

Clip 3 - Germany: A Popular, Largely Market-Based System

Clip 4 - Taiwan: A New System They Copied From Others

Clip 5 - Switzerland: Its Former System Resembled Ours

 

 

As for your question about immigration policy, I see it as an example of focusing too much on pennies and forgetting about dollars... Of being "Penny wise and pound foolish."

[TheBigDog]

A note on the metric of spending as a portion of GDP versus life expectancy. I would not expect to see a direct correlation unless the purpose of all healthcare spending was to extend lifespan. It is not. An example could be dentistry. I have crooked teeth. My parents could not afford braces for me as a kid, so I live with crooked teeth. I don't think that my lifespan will be changed by my teeth being crooked, so how would orthodontics fall in terms of being wasteful spending? My point is that such a simplistic measure of such a complex topic is a strawman used to condemn the US healthcare system. The fact that it is being used by the Whitehouse does not justify the flawed presentation of facts.

 

Bill

[InfiniteNow]

My point is that such a simplistic measure of such a complex topic is a strawman used to condemn the US healthcare system. The fact that it is being used by the Whitehouse does not justify the flawed presentation of facts.

Speaking of straw men, does your silly claim about "flawed presentation of facts" apply to the World Health Organization, as well? :dog:

 

 

WHO | World Health Organization Assesses the World's Health Systems

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.

 

<...>

 

WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

 

 

http://www.who.int/whr/2000/en/whr00_en.pdf