Monday, November 29, 2010

Markets in Everything: Cash for Fast Care in Canada

It's well known that Canada's single-payer health care system frequently results in delayed access for health care, since the "free" but still scarce medical resources get inefficiently rationed by non-price methods such as long waiting times.  For example, the median wait time in Canada for a "free" MRI in 2009 was 9 weeks, but can be as long as 15.5 weeks in some provinces (source), compared to a wait of generally less than a week in the U.S.

Here's one description of the situation in Canada:

"It's like the old Soviet system. Everything is free, but nothing is readily available. Except that we're not talking about lining up for toilet paper in Russia in 1976, but queuing for surgery in Canada in 2006."

But now there's a growing black market in Canada that allows patients to make cash payments to get to the head of the line or get the experienced surgeon they want, according to the Montreal Gazette in this article, "Want Fast Care? Slip an MD Some Cash":

 "When their mother was diagnosed with pancreatic cancer, the twin sisters didn't hesitate for a moment: They chose the surgeon they wanted and slipped him $2,000 in cash to bump their mother to the top of the waiting list.

"We wanted to save our mother," Vivian Green said. "It was cash incentive, to buy our place ahead of everyone else." Green and her sister, Ora Marcus, say bribes are an open secret in the medical field. "If you have money, you live, and if you don't, you die."

The prices?

Minimum $2,000 to guarantee that a woman's doctor will be there for the birth.  And it can go up to $10,000.For general surgery, the cost runs between $5,000 to $7,000 to jump the wait list into the operating room, he said. For Green and Marcus, the $2,000 got their mother's operation bumped up -but not the surgeon they wanted."

HT: David Henderson via Pete Friedlander

31 Comments:

At 11/29/2010 9:06 PM, Blogger cluemeister said...

And yet the socialists keep telling us what a glorious system national health care will be, despite the MOUNTAINS of evidence to the contrary.

 
At 11/30/2010 1:52 AM, Blogger randian said...

Government-created black markets aren't glorious? Report for reeducation, citizen (or just spend a day at your friendly neighborhood public school).

 
At 11/30/2010 8:15 AM, Blogger juandos said...

Hmmm, starting to see this sort of practice show up here in the St. Louis, Mo area...

 
At 11/30/2010 12:18 PM, Blogger Hydra said...

In the US you can get all the care you can afford, whether you need it or not.

In Canada you get all the care the government thinks you need whether you can afford it or not.

What's wrong with a two tier system?

 
At 11/30/2010 1:44 PM, Blogger juandos said...

"What's wrong with a two tier system?"...

What's wrong with the government staying out of the medical services market?

It adds no value to it...

 
At 11/30/2010 3:15 PM, Blogger Hydra said...

What's wrong with the government staying out of the medical services market?

It adds no value to it...

=================================

Not unless you are on the bottom of the tier.


At one point in my life I was disabled,and my medical insurance was canceled, could not buy new because I suddenly had a pre-existing condition.

My social security / medicare advisor actually suggested that I emigrate to Canada, since I could not get coverage here.

He was Canadian.

Being disabled, medicaid would pay for my doctors visits, but they were few and far between. However my prescription bill, which medicare did not cover was running up to $7000 a month.


What my experience was that it was private health insurance which added no value.

Compared to what I got from private insurance, what little I got from the government was better than nothing, because nothing was what I got from private insurance.

I was lucky. I got well, went through rehab, and back to work. For the most part, never been sick before, or since. I had a good amount of savings, but if my situation had continued I would have eventually been bankrupt.

Juandos, based on my experience, and what happened to my wife as well, you will never convince me that government mandated universal coverage has no value.

Under the former private system, I was the cherry that didn't get picked.

 
At 11/30/2010 5:36 PM, Blogger VangelV said...

What's wrong with a two tier system?

Absolutely nothing. It would solve many problems and make healthcare much better.

 
At 11/30/2010 5:40 PM, Blogger VangelV said...

Juandos, based on my experience, and what happened to my wife as well, you will never convince me that government mandated universal coverage has no value.

But it doesn't. There is a cost for everything so healthcare has to be paid for by someone. When the individual makes a decision about how to spend his own money on insurance s/he is more effective than the government deciding how much insurance premiums should cost for everyone.

 
At 11/30/2010 5:56 PM, Blogger Bob Haiducek (hi' duh sek) said...

Thanks, Hydra, for posting your comments. There are many testimonials available of American citizens who live and work outside the USA. They documented their inputs about a health-care-for-all system.

Equally important is all the current information
about the United States performance regarding the cost of health care and the health of Americans. That information documents that we will get more and pay less and cover everyone.

But note that when we implement our health-care-for-all system (Medicare for All via single-payer health care) it will be the best ... even better than the other countries.

Bob the Health and Health Care Advocate

 
At 11/30/2010 5:56 PM, Blogger Bob Haiducek (hi' duh sek) said...

Thanks, Hydra, for posting your comments. There are many testimonials available of American citizens who live and work outside the USA. They documented their inputs about a health-care-for-all system.

Equally important is all the current information
about the United States performance regarding the cost of health care and the health of Americans. That information documents that we will get more and pay less and cover everyone.

But note that when we implement our health-care-for-all system (Medicare for All via single-payer health care) it will be the best ... even better than the other countries.

Bob the Health and Health Care Advocate

 
At 11/30/2010 6:13 PM, Blogger morganovich said...

what's wrong with a 2 tiered system?

how about that they never work in practice in and but tiny super rich countries?

the government tier rapidly devolves into a despicable mess with terrible service, extremely limited treatments, and long waits. take a look at public health in the UK for a prime example.

they wind up spending as much or more than private insurance costs (and realize it's everyone being taxed, not just those using the system).

so more cost and worse health for those on the "government option". what would work better is for government to provide subsidies to buy private insurance.

what would be better still is if the whole system went to cash pay and HSA's for most medical expenses. THAT would actually drive costs down. prices for cash pay medical procedures are dropping, not going up at 4X CPI. it's fundamentally a technology and productivity business. the only reason costs are out of control is that that consumers don't face them. you shop around to fix a door ding on your car, but not to get and MRI.

health insurance should ALL have $5000+ deductibles. pay into an HSA and save against the need. if you are poor, you can get a cash subsidy into your HSA from the government instead of medicaid.

the price signal is the ONLY thing that works to clear markets.

it is the fact that we have taken it out of healthcare that the market is such a mess.

 
At 11/30/2010 8:53 PM, Blogger Hydra said...

Vange :

Of course someone has to pay for it. I paid for it for thirty-five years. Payments that went to other people for their claims. Then, when I needed to make a claim, I got zero, nada, zip. And I was barred from buying insurance, at any price, as a single buyer. Now that I am a) healthy and b) a member of a group, Vuala, insurance companies are happy to take my money again.

Yes, if you are going to have coverage, it has to be paid for.

That beats the hell out of paying and getting no coverage.

After my experience you will never convince me That government mandated universal coverage and mandatory participation has no value.

Give the insurors what they want: the biggest group possible. Then make them shell out as much as reasonable of what they take in.

Sorry, universal coverage at a bad level is better than no coverage at any level.

If you can afford more coverage, and you trust the scum to give you what you paid for, you can self insure or buy secondary insurance.

But I wouldn't wish what happened to me on even one as callous as you.

 
At 11/30/2010 9:00 PM, Blogger Hydra said...

We agree that a two tier system would work.

Isn't that what we have? I haven't been told by government that I can't hire whoever I please. Doctor or insurance company. Only difference is that next time I lose a job, the unsurprisingly cannot drop me.

What is the problem.?

That this is the camels nose under the tent?

 
At 11/30/2010 9:06 PM, Blogger Hydra said...

When an individual makes a decision on how to spend......

==========>>=====

What part of this do you not get?

I didn't get any choice. I was kicked out and barred from re-entry.

Your theory might be correct if it actually happened, but it simply did not happen that way.

 
At 11/30/2010 9:14 PM, Blogger lnulmer said...

Universal coverage will hold no value in the U.S. simply due to the people not having enough trust in our government to properly run it. It is in cases of individuals going to other countries to get insurance even though they have not paid into that system. The U.S. citizens will not be willing to have people from other nations come to the U.S. and receive health care for free.

 
At 11/30/2010 11:02 PM, Blogger Bill said...

Hydra: It seems that the insurance company would have been contractually obligated to cover you if you had faithfully paid your health insurance premiums. You should have sued them if they refused coverage. I do not understand on what grounds they could deny you coverage if you had valid insurance in place. Can you provide more information?

 
At 12/01/2010 12:04 AM, Blogger QT said...

Reality check: The location of these practices is Quebec....which isn't really representative of the rest of Canada...the rest of us just wait in the frigging line.

Waiting lines in Canada reflect the realities of political control of healthcare. Politicians have always found it very easy to cut healthcare because cuts cannot immediately be felt so that they can spend money elsewhere. Over the long term, cuts have compromised access to care...a situation which takes years to reverse.

When politicians engage in running healthcare, a field which they have little or no expertise, is it any wonder that the healthcare gets screwed up? Be careful what you wish for.

 
At 12/01/2010 8:33 AM, Blogger juandos said...

hydra says: "Juandos, based on my experience, and what happened to my wife as well, you will never convince me that government mandated universal coverage has no value"...

O.K., so you're a thief, I get it...

You just want the federal government to do your stealing for you...

 
At 12/01/2010 10:15 AM, Blogger Hydra said...

Hydra: It seems that the insurance company would have been contractually obligated to cover you if you had faithfully paid your health insurance premiums. You should have sued them if they refused coverage. I do not understand on what grounds they could deny you coverage if you had valid insurance in place. Can you provide more information?

==================================

You really don't get it.

You get sick enough to lose your job, you lose your employee health isnurance. You now have a pre-existing condition if you try to buy private insurance, and no one will touch you.

All perfectly legal, at the time, in my state. I went to the insurance commissioner with my attorney and was told, in effect, the insurance company has all the rights, and you have none.

Believe me, if there was a lawsuit I had any chance of winning, I would have tried, but you have no power in this. The insurance company has teams of lawyers on staff, and they just delay you to death. I sued (my own) auto insurance company once, and "won". It took eight years.

My only option was to extend my coverage through COBRA, which is a mandated program. Cost me something like $930 a month for the period it lasted. After that, I was on my own, until I got well enough to get a new job.

If I was still an independent consultant, I would not be able to obtain any coverage, until the new regulations under Obamacare kick in.


Now, it seems to me that anyone would be willing to buy extended coverage for six, nine, or twelve months after they leave their job, for a reasonable additional premium. If Companies are so intent on gaining new customers, why is it that no company offers such coverage, voluntarily?

Here is another catch 22. Suppose you are able to buy a short term temporary insurance. If you make a claim against it, then you will have a pre-existing condition should you become employed again, and your (new) condition will not be covered for some period of time, under your employer provided insurance. however, if you do NOT buy the temporary insurance, then the new, employer provided insurance is required to cover you, provided you don not exceed some perirod of time uninsured.

Like Cobra, this is a regulatory requirement. you cannot convince me, based on my personal experience that there is NO benefit to government mandated universal coverage and universal participation.

The cost may be high, but it is not as high as paying for 35 years and getting NOTHING.

 
At 12/01/2010 10:22 AM, Blogger Hydra said...

O.K., so you're a thief, I get it...

You just want the federal government to do your stealing for you...

==================================

No, I want insurance that provides insurance, not insurance that ends when a problem happens.

I don't mind paying for it, and I don't mind sharing the risk. the government is not stealing for me, it is preventing the indurance companies from advertising insurance that provides no insurance, or insurance that is so limited as to be valueless.

The government has said the insurance companies must provide insurance, and the trade off is that citizens must buy it.

Where is the government theft? And buy the way, werent those mandates also included in the Republican plan presented a few years ago?

 
At 12/01/2010 10:25 AM, Blogger Hydra said...

Universal coverage will hold no value in the U.S. simply due to the people not having enough trust in our government to properly run it.

================================

How is the government running it? I pay premiums to an insurance company and go to my own doctors.

Are there regulations? Sure there are. There are regulations on farming, too.

And the regulations are there for the same reason: some farmers and insurors screwed up.

 
At 12/01/2010 10:52 AM, Blogger juandos said...

"The government has said the insurance companies must provide insurance, and the trade off is that citizens must buy it"...

Well hydra I'm sorry (really I am) you're so naive about what you think is supposed to be health care/insurance protection courtesy of the progressives working for Uncle Sam...

It is just a grab for more money, even the pathetic New York Times is admitting its another government extortion program...

You should also consider that other abysmal failure, RomneyCare...

 
At 12/01/2010 12:03 PM, Blogger VangelV said...

Equally important is all the current information about the United States performance regarding the cost of health care and the health of Americans. That information documents that we will get more and pay less and cover everyone.

Get more but pay less if the government runs health care? I am not all that familiar with the US system but isn't the VA system run by the government? From what I can tell, it does not deliver care very well or very effectively because of the massive bureaucracy that forms whenever money and power are concentrated. Because the VA does not pay well there is a lack of physicians and shortages in skilled personnel required to deliver effective care.

Medicare has been a failure and has created major problems for taxpayers. Each American household is on the hook for at least $250K in future costs due to unfunded Medicare liabilities. Getting more government into healthcare will only cause that number to go up. I do not know about you but I do not consider that as being 'free' or 'cheap.'

 
At 12/01/2010 12:18 PM, Blogger VangelV said...

what's wrong with a 2 tiered system?

how about that they never work in practice in and but tiny super rich countries?


I hate to break this to you but most countries on this planet have a two tier system. There is usually a public health component that covers a certain percentage of the population through the use of public clinics and hospitals that is supplemented by a private system for those that want more and can afford it. The bottom line is that the public healthcare system has been a huge failure and has accumulated bills that will have to be paid one day. But given the huge debt levels and the sheer magnitude of the unfunded liabilities the public healthcare system is not sustainable. It is time to shrink the public component severely and to let the private sector compete for the large healthcare market just as it did in the 1950s and 1960s when people were quite satisfied with their doctors and their level of care.

 
At 12/01/2010 8:59 PM, Blogger Michael said...

We'll that's capitalism for you! The haves get. No different than in the good old USA. EXCEPT, in Canada, EVERYBODY GETS HEALTH CARE! So the Canadian system is still than our country, like ours, were millions get NO care.

 
At 12/01/2010 11:55 PM, Blogger randian said...

where millions get NO care
Got some evidence for that? Millions do indeed have no insurance, but that is not evidence they get no care.

 
At 12/02/2010 11:31 PM, Blogger Bob Haiducek (hi' duh sek) said...

Radian there is VERY MUCH EVIDENCE that millions of people get no care. Look at the charts and see how little we get to the doctor compared to other countries. See how badly we perform in terms of amenable mortality (avoidable deaths before age 75) and maternal mortality (17 vs. 7 ... now THAT is BAD) ... and life expectancy.

The charts are here: http://www.mforall.org/pages/Six_Countries
about the United States performance regarding the cost of health care and the health of Americans. That information documents that we will get more and pay less and cover everyone.

Americans who live and work in other FREE-MARKET countries know that there is better out there. There are many testimonials available: http://www.mforall.org/pages/Testimonials available. They documented their inputs about a health-care-for-all system.

But note that when we implement our health-care-for-all system (Medicare for All via single-payer health care) it will be the best, better than the other countries, as explained here: http://www.mforall.org/pages/Best ... even better than the other countries.

Bob the Health and Health Care Advocate

 
At 12/03/2010 8:34 AM, Blogger VangelV said...

Radian there is VERY MUCH EVIDENCE that millions of people get no care. Look at the charts and see how little we get to the doctor compared to other countries....

But this is not true. If an American goes to a hospital and chooses a private room with an extra bed for a loved one, Cable TV, specialty meals and a doctor rather than a nurse as the primary care giver prices are very high. But if one is willing to go with a no frills option, which is what most OECD hospitals force people to take when issuing taxpayer funded care, the price drops sharply.

The American system is screwed up because it is so highly regulated that effective delivery at a low cost is very difficult to deliver. But that does not really make it much more expensive than what other countries get if we do an apples to apples comparison by stopping to offload costs to other parts of the government budget and look at all costs that go into healthcare delivery.

The charts are here: http://www.mforall.org/pages/Six_Countries...

What a joke. Medicare does not lower costs; it makes delivery of cost effective healthcare more difficult by prohibiting such things as nurse centered prenatal activities.

 
At 12/03/2010 10:34 AM, Blogger VangelV said...

We'll that's capitalism for you! The haves get. No different than in the good old USA. EXCEPT, in Canada, EVERYBODY GETS HEALTH CARE! So the Canadian system is still than our country, like ours, were millions get NO care.

What exactly is wrong with capitalism again? Would you rather have the world stuck being poor and sick rather than wealthy and healthy?

Hans Rosling's 200 Countries, 200 Years, 4 Minutes

 
At 12/06/2010 12:52 AM, Blogger Bob Haiducek (hi' duh sek) said...

Radian ... My first reaction to your post was one of interest in the challenge of responding. But you have zero references to anything that would support your statements.

I not only state that there is evidence, but I provided the supporting data. You responded with "But this is not true."

You wrote "The American system is screwed up because it is so highly regulated". Interesting. The state of New York applied regulations to health insurance companies. See the result. I appreciate that this is different kind of regulation, but the mess of too much regulation is in our future if we let Obamacare proceed much farther. You ain't see nuttin' yet.

You wrote "Medicare does not lower costs". Then you state what Medicare prohibits. Note this clarification: I am not talking about Medicare ... the relatively poor health system that we have today that we call Medicare. I compared it and posted it. Not good. You can see the comparison

"Medicare for All via single-payer health care" is an improved Medicare. See that comparison link.

Yes, "Medicare" prohibits things, as you wrote. "Medicare for All" provides all medically-necessary care.

Bob the Health and Health Care Advocate

 
At 12/07/2010 5:23 PM, Blogger VangelV said...

"Medicare for All via single-payer health care" is an improved Medicare. See that comparison link.

Sorry Bob but if you really believe what you say you are a total idiot. If you really believe it why are you not advocating for single payer phone, cable, internet, food, automobiles, tuition, and all kinds of other goods and services that people consume?

 

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