Americans talk about wait times in Canada. My experience is that I have had procdures done here much faster than it used to take me to get insurance company approval, let alone procedures, in the US.

I have had two serious, but not particularly urgent surgeries.

I had a serious but not urgent kidney injury from playing football as a 20 year old. I was referred to a Urologist in the city (I lived in a small town then) and saw him on the third day, after seeing my GP on the same day as the injury. The Urologist put me in hospital that same day, did testing and X-rays the fourth day and surgery on the fifth day after seeing my GP. The testing had shown that the injury was localized in the upper pole of the left kidney, so he was able to only remove that affected half, all done in five days of the injury.

Two months ago I went to my GP with vocal hoarseness. He suggested I see an otolarygologist. I got that appointment in 7 days, and had surgery for a laryngeal lesion (later pathology showed it was benign) 2 days later which also included surgical vocal cord reconstruction all within 10 days.

My mother had bypass surgery at age 72 within 2 1/2 days, most of which was because the cardiac surgeon wanted her more stable to improve her chances of surviving the surgery.

She also had cataract surgery at age 77. Time from diagnosis to surgery, 14 days.

I have always had excellent, efficient, and very high quality care by both physicians and hospitals in Canada. My experience in the US was more about insurance company interference with care and denial of care than it was about health care. I wasn’t overly impressed with the quality of care I had in the US either, measuring it against what I had experienced here.

Universal and unlimited access to physicians, particularly primary physicians, enables problems to be dealt with when they are small and treated with far better outcomes and treated far more cheaply.

My opinion from my experience in the US is to take off the blinders and quit the hype about US superiority. In my opinion the US has a lot to learn about both access and quality from other countries.

http://www.afcm.org/fascisthealthcare.html

I think we would have to actually speak with some insurance executives about this and see where they stand on the feasability of various structures.

That was already answered in a hearing in Congress, where insurance company executives basically described some rather customer-unfriendly business practices like looking for excuses to rescind policies as soon as the policyholder got an expensive medical problem.

Another point, though, is that insurance is so expensive, in part, because it has grown to envelop routine care. Visits to your doctor, routine prescription drugs, etc. are all now handled by insurance. This has divorced the patient from direct costs and leads to a continual demand for more from the insurance company.

While in theory, insurance is most efficient when it covers only catastrophic losses, medical care is a situation where it is often “pay a little now or pay a lot later” for the same problem, but most people balk at paying a little now (remember the story of the kid who died because his mother did not want to get his cavity filled, which later led to a fatal infection?). So insurance schemes offered by employers often include checkups and routine care because it is cheaper to catch problems when they are cheap than to deal with them later when they are more expensive.

Note also that many people choose lower deductibles on the car and homeowner / renter insurance than are probably optimal for their situation. Moving over to medical insurance, high deductible plans are not popular at all, either in the marketplace (for either individual or employer group plans) or in political discussions happening these days.

Of course it is inefficient to run every small charge through insurance company bureaucracy (which also gives them a chance to mess up the claim payment or inappropriately deny what they say is a covered claim). Unfortunately, that seems to be what most people want, and what is needed to give most people an incentive to get routine care.

Your second point is simply lost on me. Insurance can work in many ways – and it wouldn’t necessarily revert to some equivalent of paying to the insurance company what they are paying out for your medical care. I think we would have to actually speak with some insurance executives about this and see where they stand on the feasability of various structures.

Another point, though, is that insurance is so expensive, in part, because it has grown to envelop routine care. Visits to your doctor, routine prescription drugs, etc. are all now handled by insurance. This has divorced the patient from direct costs and leads to a continual demand for more from the insurance company. I’m not sure, really, why this has happened. Did Medicare begin this trend and others found it necessary to follow suit? Did Blue Cross and Blue Shield (who apparently, early on, got significant tax breaks) encourage this idea – and other insurers had to compete with them? Anyone who knows the answer please chime in.

Insurance companies don’t know what will happen to you in the future any more than you do.

Actually, medical costs are very predictable in many cases, since they are not like many other perils that happen at unpredictable times and finish occurring within a day (car crashes, house burning down, theft, etc.).

If a doctor tells you that you have non-skin cancer, recommending various treatments that should be scheduled in the near future, both you and any insurance company seeing your medical records will know your near future medical bills without having to look up any actuarial tables. It is not like a car crash, where your doctor tells you that you have non-skin cancer and does all of the treatment in the same day. In this case, the insurance company has an incentive to drop the customer as soon as it can after finding out the diagnosis, in order to avoid paying for any of the scheduled treatment.

The way to make a market-based system work is to create a mechanism where you can buy insurance to insure your insurability for medical insurance. As it would be in an unfettered market, medical insurance would just be prepaid medical care, with costs approximating actual medical costs to an individual due to the predictability of actual individual medical costs, rather than a risk-sharing mechanism that insurance is meant to be. Insurance policies to insure insurability would put the risk-sharing mechanism back in.

But that idea does not seem to be mentioned by anyone.

Anonymous,

I think there are an infinite variety of health conditions (each person’s health is different and potentially more or less potentially costly to an insurance company). Insurance companies don’t know what will happen to you in the future any more than you do. That is why they have actuarial tables and statisticians trying to calculate these things. You have to really change your perspective and realize that insurance companies are actually providing a valuable service that both you and I would like to take advantage of.

Now, logically, if I am free to set my price to any amount, then, logically, there is NOTHING that would prevent me from offering insurance to a particular person. in addition, if I can limit that insurance to certain types of outcomes (to be defined in the contract that is signed) then I can also limit my exposure. Under the current system, neither of these conditions is true. Health insurance companies are highly regulated, mostly by states. This results in them not being free to sell insurance at any price and not being free to offer any product (in this case, a limited one). The end result is that certain people are simply not offered insurance. This is simply another example of price controls leading to shortages, as they do in other markets.

Now could I imagine a person who current does NOT have insurance and who has a horrible disease, and for whom the cost of insurance will probably be too high? Of course. You can always imagine a horrible scenerio that may, in a few cases, actually come true. Such people will have to depend on the good will of family, friends, hospitals, and charity organizations.