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The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resour

The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resources because they pursue health care in the degree they feel they need it, irrespective of money. Some are constant complainers craving attention, some are tough-as-nails cowboys who don't need a doctor to pull the bullet out; overall, Canadians are pretty reasonable about their as-needed consumption, as demonstrated by per-capita health care spending. The problem in the U.S. is that health care costs are directly tied to your employer, mostly, because the employer is the cost-savings insurance pool you join. This creates a lot of terrible situations where people are stuck in jobs they can't afford to leave for medical reasons; or are stuck with medical problems that prevent them from getting hired. What was originally supposed to be a social contract where you work hard to have a good career, and your boss takes care of the ugly bits of life like cancer, has turned into a tight coupling of disjoint life issues that usually creates the worst possible outcome in both cases. Medicaid is terrible largely because it's legislatively hobbled to prevent it exercising market power (like negotiating bulk pricing for pharmaceuticals, because doing so would embarrass capitalism somehow), and otherwise regulation driven for political purposes, like capping payments for procedures at below market rates, causing them to be excluded from a large number of health care providers who don't need to submit to price controls. The U.S. health care system is like a graduate thesis in perverse incentives.

rosser 9y ago
I'd read that the way healthcare became tied to employment had less to do with some beneficent interpretation of the "social contract" than it did taxes. That is, when the two were first tied, income tax rates (especially for higher, including "professional", brackets) were much higher. Employer-sponsored insurance was first offered as a tax-free perk companies could use to draw talent. It's easy to see how that could become an expectation, and then a requirement, despite its helping create incentives that are ultimately aligned against the employee/patient.
- eric_the_read 9y ago
  In 1943, the War Labor Board ruled that wage freezes due to WWII did not apply to fringe benefits, which included health insurance. So you couldn't pay your employees more money, but you could pay their health insurance.
alacombe 9y ago
> The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resources because they pursue health care in the degree they feel they need it, irrespective of money. Which lead to a 6 month delay to get an MRI in BC (which proud itself to be no. 1 province). Not to mention that the public insurance does NOT include dental, or if it does, only the bare minimum. I had to personally pay for a root canal because only a complete extraction was being reimbursed. Moreover, all my cleaning have been out of MY pocket, on top of MSP/RAMQ. I really don't get why Canadian think their healthcare is so star sprangling awesome... It's not.
- the_mitsuhiko 9y ago
  > Which lead to a 6 month delay to get an MRI in BC (which proud itself to be no. 1 province). Not to mention that the public insurance does NOT include dental, or if it does, only the bare minimum. I had to personally pay for a root canal because only a complete extraction was being reimbursed. Moreover, all my cleaning have been out of MY pocket, on top of MSP/RAMQ. But isn't that what makes it great? I have no experience with Canada but Austria is not very different in that regard. My state insurance costs me (purely medical) around 5000 Euro per year independent if I self insure or through my employer. It gives me about what Canada gives you. No copays for employees and there is a 10% or 20% copay for self employed or management. In addition I pay about 3000 EUR a year extra for private insurance. I did not feel like waiting 2 months for an MRI so I decided to use my private insurance at a private carrier. Paid 500 EUR for that out of my pocket and the private insurance reimbursed everything but the contrast agent. I could also decide not to pay for my private insurance at all but I did the math and the plan I have now seems a pretty good way to spend money for later in life. It gives me the freedom to chose what I want. The cost for most non covered procedures is laughably cheap here. It seems like a better deal for my money.
  - freeflight 9y ago
    >I did not feel like waiting 2 months for an MRI so I decided to use my private insurance at a private carrier. I wonder what's up with all those MRI shortages in some places? I got my last MRI a couple of years ago in Germany, fully covered by public insurance, had to wait like 2 weeks for my appointment. Sounds like some places are in dire need of more MRI capacity?

rosser 9y ago

I'd read that the way healthcare became tied to employment had less to do with some beneficent interpretation of the "social contract" than it did taxes. That is, when the two were first tied, income tax rates (especially for higher, including "professional", brackets) were much higher. Employer-sponsored insurance was first offered as a tax-free perk companies could use to draw talent. It's easy to see how that could become an expectation, and then a requirement, despite its helping create incentives that are ultimately aligned against the employee/patient.

eric_the_read 9y ago
In 1943, the War Labor Board ruled that wage freezes due to WWII did not apply to fringe benefits, which included health insurance. So you couldn't pay your employees more money, but you could pay their health insurance.

alacombe 9y ago

> The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resources because they pursue health care in the degree they feel they need it, irrespective of money. Which lead to a 6 month delay to get an MRI in BC (which proud itself to be no. 1 province). Not to mention that the public insurance does NOT include dental, or if it does, only the bare minimum. I had to personally pay for a root canal because only a complete extraction was being reimbursed. Moreover, all my cleaning have been out of MY pocket, on top of MSP/RAMQ. I really don't get why Canadian think their healthcare is so star sprangling awesome... It's not.

the_mitsuhiko 9y ago
> Which lead to a 6 month delay to get an MRI in BC (which proud itself to be no. 1 province). Not to mention that the public insurance does NOT include dental, or if it does, only the bare minimum. I had to personally pay for a root canal because only a complete extraction was being reimbursed. Moreover, all my cleaning have been out of MY pocket, on top of MSP/RAMQ. But isn't that what makes it great? I have no experience with Canada but Austria is not very different in that regard. My state insurance costs me (purely medical) around 5000 Euro per year independent if I self insure or through my employer. It gives me about what Canada gives you. No copays for employees and there is a 10% or 20% copay for self employed or management. In addition I pay about 3000 EUR a year extra for private insurance. I did not feel like waiting 2 months for an MRI so I decided to use my private insurance at a private carrier. Paid 500 EUR for that out of my pocket and the private insurance reimbursed everything but the contrast agent. I could also decide not to pay for my private insurance at all but I did the math and the plan I have now seems a pretty good way to spend money for later in life. It gives me the freedom to chose what I want. The cost for most non covered procedures is laughably cheap here. It seems like a better deal for my money.
- freeflight 9y ago
  >I did not feel like waiting 2 months for an MRI so I decided to use my private insurance at a private carrier. I wonder what's up with all those MRI shortages in some places? I got my last MRI a couple of years ago in Germany, fully covered by public insurance, had to wait like 2 weeks for my appointment. Sounds like some places are in dire need of more MRI capacity?