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Dear B. H. Obama...We Told you So.

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wasteful View Drop Down
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    Posted: Jun 01 2010 at 5:28pm

Soaring costs force Canada to reassess health model

By Claire Sibonney - Analysis Claire Sibonney - Analysis Mon May 31, 2:38 pm ET
 
TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.

Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.

British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.

And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.

It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.

"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.

"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.

"At some stage we're going to hit a breaking point."

MIRROR IMAGE DEBATE

In some ways the Canadian debate is the mirror image of discussions going on in the United States.

Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.

Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.

Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.

But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.

"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.

Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.

"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.

Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.

Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.

"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.

The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.

In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.

WINNERS AND LOSERS

The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.

"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."

Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.

"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"

But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.

"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."

($1=$1.05 Canadian)

(Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway)

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lrisner View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lrisner Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2010 at 2:17pm
Your right! It would be cheaper to let those uninsured just shrivel up and  Die! Of course if all those deadbeats would get Jobs, huh?


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Post Options Post Options   Thanks (0) Thanks(0)   Quote wasteful Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2010 at 7:28pm
Typical Lib response there old Irisnerkov, deadbeats getting a job instead the ole nanny state treatment from the Dems, what a Novel idea.  Ah, but the Dems/libs/socialist they prefer to drag the whole system into the ground so that we can all be equal.  By 2020-25 this program will be a $2,000,000,000,000.00+ fiasco that will wreck the system entirely.  Only hope is Obama gets the Jimmy Carter treatment in 2012.....Thumbs%20Up...at the rate things are going it looks like a good possibility.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rngrmed Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2010 at 10:08pm
I learned when I was working on my undergrad, death is definitely cheaper than most of these radical treatment most people receive. Health care is costing the United States a fortune. Other countries as well and I'm glad President Obama had the balls to address the problem, but I think he rushed to get something done.  A lot of people that the health care system in the United States needs reform often look at Canada and England as examples.  Just like Canada is being forced to reassess their healthcare, England was too.  England was forced to pour a ton of money in to their system.  Other countries that make it work are the Asian countries, but physicians are grossly underpaid.  President Obama has said the his recent enacted changes are just the first round, I just hope he sees the failures in the European models. 
Wasteful, I don't think anyone is looking to drag the whole system down. There NEEDS to be an overhaul. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mike_Presta Quote  Post ReplyReply Direct Link To This Post Posted: Jun 02 2010 at 11:43pm
Originally posted by lrisner lrisner wrote:

Your right! It would be cheaper to let those uninsured just shrivel up and  Die! Of course if all those deadbeats would get Jobs, huh?
Let's boil this down to the very basics:
 
If you DON'T work, the government GIVES you money, goods and services.  If you work, the government TAKES your money yet you must pay for goods and services.
 
The LESS you make, the MORE the government GIVES you.  The MORE you make, the MORE the government TAKES from you.
 
The "opinion" (vote) of a non-worker counts the same as the "opinion" (vote) of a worker.
 
Can anyone figure out why this cannot work in the long run???
Can anyone explain how this can possibly work in the long run???
 
ANYONE???
“Mulligan said he ... doesn’t believe they necessarily make the return on investment necessary to keep funding them.” …The Middletown Journal, January 30, 2012
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Post Options Post Options   Thanks (0) Thanks(0)   Quote VietVet Quote  Post ReplyReply Direct Link To This Post Posted: Jun 03 2010 at 11:11am
rngrmed- I'd like to make a statement regarding your comment about physicians being grossly underpaid. You should know that I am not in the medical field and am just asking questions here.

An example I'd like to use is our family physician, Dr. Strait at Summit Family Physicians.

Dr. Strait has voluntarily signed up for the Anthem medical system (primary carrier) which is what our family has through my employer with a secondary carrier of Medicare Part B for the wife only.

We pay a co-pay of $20 per office visit. His charge to Anthem is $135. per visit. He is paid $95. by Anthem plus our co-pay of $20. Medicare pays nothing as the wife is not 65 as yet, but still charges monthly from her paycheck. (It is worthless until she reaches 65- then becomes primary for her only). From this $135. charge, Strait receives $115, writing off $20. He is willing to accept this reduction on an on-going basis.

Question.....if this physician is grossly underpaid, why does he sign up with a healthcare network that he knows will not pay him the full amount for a routine office visit? If physician's feel that they are underpaid, why do most of them sign on to agree to take a lesser amount for their services from a medical plan? Thanks in advance.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Hermes Quote  Post ReplyReply Direct Link To This Post Posted: Jun 03 2010 at 11:30am
Mike - It's the Robin Hood system. Take from the haves until the haves become the have nots. Then you find more haves, take from those haves until they become the have nots. Eventually everyone is  have not and then China comes in and completely takes over inviting the Mexicans because of cheap labor then the Mexicans eventually become have nots and China leaves and the British take over spilling oil & telling lies then they leave which leaves us with a mess because we are all have nots & the Mexicans have all gone back to Mexico and now we are such a mess no one wants us and our have nots because we can't buy anything due to no jobs and low paying jobs that only the haves have money and they won't spend it in this country because this country is a bad investment so the haves go else where and that leaves all the have nots in worse shape so the government borrows to provide even more have nots to make them haves but it's not enough so they remain have nots and the haves are getting tired of providing for  the have nots so all the haves quit working creating more have nots thus forcing the government to borrow more to pay the have nots not to have anything because it's cheaper to be a have not than to be a have who pays all to a government who likes creating have nots by taking away all they have.Wacko Dead
No more democrats no more republicans,vote Constitution Party !!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rngrmed Quote  Post ReplyReply Direct Link To This Post Posted: Jun 03 2010 at 11:44am
VietVet--When I mentioned that physicians were grossly underpaid, I was referring to physicians in Asian Countries that are supposed to have a way of delivering healthcare to all of its citizens.  Atleast that is what research tells us (whatever that is worth). 
Physicians usually limit how many people they will take from a certain insurance (unless the insurance company dictates that too).  In the US, physicians can only make money by seeing patients. The more you see, the more money you make.  Hence, the quick in and out.  In England, physicians are paid a certain rate no matter if you see the patient 30 times a month or 0 times a month.  But they are given incentive bonuses in the British healthcare system too.
Malpractice is out of control here.  Then again, I've been fortunate to not have an injury or a bad diagnosis yet too.  Been close but fortunate.  I once saw 5 different doctors for the same problem and have 5 different diagnoses.  Wasn't Dr. shopping, each referred me to the next. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rngrmed Quote  Post ReplyReply Direct Link To This Post Posted: Jun 03 2010 at 11:51am
I agree with Mike.  I hate to see people come in to the hospital that need help and can't pay.  My heart goes out to them.  Maybe that is the nurse part in me.  And I can rationalize that if a person gets sick and loses their job they need help.  Which from reading posts in here for over a year now, I think most agree with that.  But there comes a time when you can work, you need to get out there and get a job.  They need to be available though. 
Our Government has done nothing but foster the feelings of "the world owes me something".  And that is a problem.  Offering to help out of kindness is one thing, helping because people think it is "owed" is completely different.  Especially if they have NEVER contributed to the system. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Bobbie Quote  Post ReplyReply Direct Link To This Post Posted: Jun 04 2010 at 7:52am
Well the problem with people getting a job - is there is not any. 

Physicians are actually over paid.  When you go to a DR visit and the total bill is 135 for a basic visit, that you see the DR for about 5 -10 minutes.  That seems high, but it is reality.  I understand that the reason for the fees is the malpractice insurance.  Does it not make sense that the issue is in the lawsuits?  Insurance companies just settle, when they feel it will cost them less then to go to court.  Either way the premium goes up for the DR.  IMO, this would have been the first area to start some reform.  I would love to know the statistics for how many stupid lawsuits there are to legitimate ones. 

I do know of a DR in town that no longer carries malpractice insurance, no longer has any assets in his name either.  Does not sign up for any insurance, just sees people as out of network, and he still gets paid.  You can sue him all you want, but there is nothing to take. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Pacman Quote  Post ReplyReply Direct Link To This Post Posted: Jun 04 2010 at 9:25am
There is far more driving the cost of Health Care in the USA than Physician visits.  In my house if I had to buy the drugs that are used it would cost me $2700.00 a month on the open market without insurance.
 
A $9000.00 visit to Atrium ER and stay of 1 day in the Hospital, of that $9000.00, $4000.00 was Pharmacy/Drugs/IVs,  $2400.00 was ER, the rest was for the room, etc.
 
Just the Co-pays each month for Drugs and the cost of Health Insurance alone is more than my House Payment.
 
The USA is basically footing the bill for Pharmaceutical research for the rest of the world with outrageous Drug prices forced on its citizens and basically OK'ed by the Government
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rngrmed Quote  Post ReplyReply Direct Link To This Post Posted: Jun 04 2010 at 12:28pm

PacMan, you're right, the cost of healthcare is more than just physician costs.  Technology drives up costs. Pharmaceutical companies claim research is the reason for their high prices but much of their costs is advertisement.  I don't see the representatives in the hosptials much anymore but the still visit Dr.'s offices.  The representatives bring food, pens, stethoscopes and whatever else they can put their name on. Even give the docs money to use their drug.  Most new drugs are essentially the old drug with a different additive (same active ingredient) with a different name.  That way they can keep their patent.  While charging you more.  I think hospitals charge about $9 for 1 tylenol!?!

This is an area where Japan's system helps them thrive.  Companies that deal in medical technology can only charge so much for their products and the Government limits hospitals what they can charge for procedures.  But I think even Japan is having trouble with their system.  Need more Dr.'s.  Propaganda says everything is fine but if you listen to the healthcare workers, it is from ok.  Ton of education and no reward.  Why do it?
I think that is part of the purpose of requiring everyone to have insurance. So everyone pays something. 
I think Obama really needs to address insurance plans next and do it fast.  Help bring those costs down and what is covered.  Allow out of state competition for one.  Piece your plan together.  Pay for what you need. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Pacman Quote  Post ReplyReply Direct Link To This Post Posted: Jun 04 2010 at 6:30pm
If this is true, this is where Obama needs to start.  Problem is Obama already made a deal with the Pharmaceutical Companies.
 

January 03, 2008

Do drug companies do more marketing or research?

There's an intriguing new study in this week's PLOS Medicine, an online, open-access journal. It concludes that the pharmaceutical industry spends nearly twice the amount of money on drug marketing and promotion than it does on research and development.

In their analysis of data from two market research companies, IMS and CAM, Marc-André Gagnon and Joel Lexchin (York University, Toronto, Canada) found that US drug companies spent US$57.5 billion on promotional activities in 2004, the latest year for which figures were available.

In comparison, the National Science Foundation reported that in 2004 the amount of industrial pharmaceutical research and development (including public funds for industrial research and development) was US$31.5 billion in the United States.

For the last 50 years, say the authors, there has been an ongoing debate as to which image of the drug industry is most accurate. The industry promotes a vision of itself, say the authors, as "research-driven, innovative, and life-saving," but the industry's critics contend that the drug industry is based on "market-driven profiteering."

The study confirms the more cynical view that drug companies are out to profit first, and save lives second. And there's nothing wrong with that.

However, it's a reminder that we must view drug companies with eyes wide open, as we should their relationships with doctors. (An excellent account of the dark side of the relationship between docs and big pharma can be found in Dr. Jerome Kassirer's excellent On the Take.)

Finally, the study calls to mind the sobering power of direct-to-consumer-advertising, which the Government Accountability Office reviewed in 2006. This practice generally prods the public to spend more money on costlier drugs they don't necessarily need, or when a cheaper, generic alternative might be just as effective.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote rngrmed Quote  Post ReplyReply Direct Link To This Post Posted: Jun 04 2010 at 7:46pm
PacMan-  My personal experiences would say that study is completely true.  Some doctors' offices have a different drug rep. in there every day of the week with drug samples, food for 20-30 people and other supplies that I mentioned earlier.  Let's not forget all the commercials we see.  Banners at ball parks and other activities.  Cars for the reps to go around. 
And it pays off.  You notice a problem you go to your doc and ask for specific med.  You have a cold, you ask for antibiotics whether you need them or not.  People want a pill to make their problem go away.  Especially when have advertisements in their face 24 hours a day.
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