General Discussion
In reply to the discussion: My wife will get her meds [View all]Zorra
(27,670 posts)Last edited Thu Mar 20, 2014, 02:49 PM - Edit history (2)
none of us should have to deal with the frustrating maze that is for profit health insurance.
It's such a frustrating, emotional energy blasting waste of time. Most of us have busy lives, and don't need every second of our free time consumed by things like being put on hold for a half hour when trying to find out if our health care needs will be covered, and then struggling with bureaucracy ("I'm going to transfer you to Irma Gardnotagin over in Customer Care" as you scream while really shitty digitally detracted music begins to play, music that is designed to get you to give up while you are on hold for another half hour waiting for Irma over in Customer Care to pick up as she does her nails while not answering your call for the half hour prescribed in the corporate protocol manual under the section entitled "101 Ways To Make The Mark Customer Give Up Trying So We Can Burn Them And Increase Profits".
As you put speakerphone on and wonder, "Geez, this company made record profits in the gazillions of dollars range last year...you'd think they could hire more staff to expedite customer service!"
One problem (among many problems) people commonly have is not understanding deceptive for profit health insurance terminology. When dealing with for profit health insurance companies, what you don't know can, and probably will, hurt you. For profit health insurance companies rely on customer ignorance for increased profits.
The devil is in the details, and things don't always mean what they appear to say. And even people who are educated, literate, and have relatively high IQ's get duped sometimes. Every US health care provider's intake staff has stories about nightmare time consuming dealings with the deviousness, evasiveness, and doublespeak of for profit health insurance companies. If they can even scam the professionals, imagine what old Mack DeNife in Sales & Marketing does to folks who can't read all that well.
I wonder how much extra profit is generated for these companies per day through customer ignorance and error. I suspect it is millions of dollars, collectively.
Health care in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities.[2] It is guided by the provisions of the Canada Health Act of 1984.[3] The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician.[citation needed] Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing.[4]
Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes. In British Columbia, taxation-based funding is supplemented by a fixed monthly premium which is waived or reduced for those on low incomes.[5] There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income).
A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care.[6] There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, health care cannot be denied due to unpaid premiums (in BC), and there are no lifetime limits or exclusions for pre-existing conditions.
Pharmaceutical medications are covered by public funds for the elderly or indigent,[7] or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Preventive care and early detection are considered important and yearly checkups are encouraged.
http://en.wikipedia.org/wiki/Health_care_in_Canada
Why pay more?
Everybody wants Canadian drugs for one reason: Brand-name meds are cheaper there. A 2012 report found, for example, that a 30-day supply of Cymbalta (used to treat depression or chronic pain) typically costs $149 in the United States, compared with $113 in Canada; Nasonex (used for allergies) was $105 in the U.S. and only $29 in Canada.
These price differences are due to the unique way that the U.S. handles its pharmaceutical marketplace. In most other countries, governments either set pricing caps or negotiate lower prices directly with drugmakers. In the U.S., pricing is determined by market competition among pharmaceutical companies, which have little incentive to keep prices down.
When accused of price gouging in the U.S. market, the companies claim that the high costs are required to pay off sunken research and development costs averaging over $1 billion per drug, according to Pharmaceutical Research and Manufacturers of America. The claim has been debated, with some studies estimating the cost at more like $50 million to $75 million. Regardless, because other countries force pharmaceutical companies to sell drugs cheaply abroad, U.S. residents are stuck with the bill, essentially subsidizing the affordable prescription drugs in other countries.
snip---
When he was drafting what would eventually become the Affordable Care Act, President Barack Obama considered adding a section that would enable Medicare to negotiate drug prices. However, he gave that away as a bargaining chip to gain the overall support of the pharmaceutical industry.
http://america.aljazeera.com/articles/2013/11/7/is-canada-the-answertohighpriceofmedsinus.html
Free Market Capitalism: Let The Buyer Beware.