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Problems with Health Care and Insurance and the Canadian System

November 1st 2005

Problems with Health Care and Insurance and the Canadian System

Can the US System be Fixed

I've looked at the Canadian "healthcare" system pretty regularly over the past few years, and they really are not all that happy with it. Canadians who can afford it, and cannot (or think they cannot) afford to wait, cross the border for their healthcare procedures, particularly if it involves a large machine like an MRI or a CAT scan (or similar).

The problem with Healthcare Insurance in the United States is pretty complex: First, you have too many people getting something for nothing; that overburdens the doctors, who have to make a profit, too, and the hospitals, who have to make a profit ... and at who's expense do you suppose they are going to exact that profit? So they drive up the cost of caring for people.

Second, you have a society that is all too happy to sue just about anyone for just about anything. A Doctor is highly educated, to be sure, but every doctor I know makes mistakes. They're human, after all; and all it takes is that ONE mistake on or around that ONE guy or girl who wants to turn it into a spin at the Lotto with virtually guaranteed results. To fend off all the lawsuits, any MD worth their cotton balls invests heavily in Malpractice Insurance; which costs them plenty and, as we've already discussed, doctors have to make profits, too ... and so the cost gets passed on to the consumer or their insurer, whichever is the easiest from whom to collect.

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Then you have the insurance companies themselves who are almost CONSTANTLY trying to bid the doctor's bill down: They base this bid-down price on a formula that uses what they call "the prevailing competitive price," but I have yet to find a doctor (who, by the way, in case I didn't mention it, has to make a profit so that he can live) who actually charges the PCP. SO, if the MD doesn't alter the bill, the victim...I mean, the patient gets to cover the overage which is in ADDITION to any deductible or co-pay.

Finally, you have the patients, themselves. We are increasingly a society of hypochondriacs. Whereas our fathers and mothers typically treated their own colds and flu at home as well as those of their children, today's family is more likely to make a cough into a visit with the pediatrician. The medical community has convinced us we cannot tell whether we have a cold or a flu, and that it's important that we know the difference (even though the Tx is nearly identical and there is nothing you can do to actually CURE either one). SO, whereas actuarially sound rates might be based on 4-6 trips per year to the MD or specialist, the average human bean visits his or her MD upwards of 8 or 9 times (these aren't real numbers, I don't know the real numbers...just using these for explanatory purposes).

SO, what's the solution?
  1. Put emergency medical care under a seperate, state-controlled system and pay for it with some kind of "use" tax on something widely available and that just about everyone uses.
  2. Forbid lawsuits against doctors or hospitals unless the actual damages exceed a strong, and high, economic threshold (like, say, $100,000) and, then, limit awards to only the actual damages...no "punitive" damages. If the doctor was NOT negligent, but actually did the misdeed purposely, then arrest him or her, try him or her, make his or her estate pay everything to the victim, and throw him or her in jail.
  3. Allow Doctors to charge as much as they need to charge to earn a profit; which will be lower than they charge today because they won't need as much (or any) malpractice insurance...and they won't be treating people for free.
  4. Limit the number of trips a body can make to the MD for superfluous crap like colds and flu (unless life threatening, for example, to an asthmatic or the elderly).
  5. Enjoin insurance companies to work WITH the doctors on loss mitigation programs like "heart smart" and "Beating Diabetes." Insurance agents and companies can be very large knowledge repositories and they are almost expert at risk management...use them.
That's how I see it, anyway...from the inside.

By Dave Davis
Dave is an insurance specialist living in the Midwest

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Copyright 2005 Best Syndication                                            Last Updated Saturday, July 10, 2010 09:39 PM