Comparing US health plans with those of Canada  

                                                

Comparing the health plans between the US and Canada is like trying to compare apples and oranges. There simply is no comparison.

Health care in the United States

The market-based health insurance system in the United States has caused a human rights crisis that deprives a large number of people of the health care they need.  The most visible problem is the 32 million people without health insurance. What is  most distressing is the number of preventable deaths—up to 101,000 people per year  which is  simply due to the way the health care system in the US is organized.

This crisis persists despite available resources to protect the right to health, record levels of health care spending and constant repeated health reform efforts. Since social determinants, such as race, income and environment have strongly influenced who becomes ill and who receives access to quality care, the health care crisis disproportionately affects disadvantaged groups and under-resourced communities, such as people living in poverty, people of color, and immigrants.

Despite the existence of barriers to accessing care, the burden of medical debt and the shortage of primary care providers has affected all people in the US including those with employer-sponsored insurance. Overall, the health care crisis in the US is the result of the privatization and commodification of the U.S. health system, which reflects market imperatives and profit interests that devalue human needs, dignity and equality.

Has there been any improvement prior to the time when  President Obama was in power?  In that era, Americans had a higher infant mortality rate and lower life expectancy than comparable countries in 2007, The U.S. has the highest rate of maternal mortality among high-income countries (13 in 100,000), and also the highest rate of C-Sections (32%), as opposed to a recommended (5-15%) As many as 45,000 people died each year simply because they had no health insurance according to the American Journal of Public Health (2009)

Approximately 50 million people did not have health insurance. Over half of them were African Americans, according to the Center for American Progress (2009) Of those who were insured, at least 25 million were underinsured. They had often  chosen to forgo health care because of high deductibles according to  the Commonwealth Fund (2008)  As many as 700,000 families went  bankrupt each year just by trying to pay for their health care even though three quarters of them had some form of Health insurance according to Health Affairs (2006). In comparison, the five largest insurance companies made a combined profit of approximately $12 billion in 2009.                                      

The United States had fewer doctors and nurses than other high-income countries according to the World Health Organization statement made in 2007. Unfortunately, Hospitals and doctors were disproportionately located in wealthier areas instead of being evenly spaced.  As a result,  public hospitals were closing in areas where they were most needed. The U.S. ranked lowest among high-income countries in its primary care infrastructure. There was a projected shortage of 44,000 primary care doctors within the next 15 years.

 

The rights of people of color are violated: e.g., the 10-year survival rate for Black people of people with cancer is 60% for Whites and 48% for African Americans according to the SEER cancer statistics, also the Office of Minority Health

The quality of care given to people of color was generally lower, (Is that a surprise?) including in the treatment of cancer, heart failure, and pneumonia according to the Agency for Healthcare Research and Quality, statement made in 2009.

While immigrants are generally healthier than the average citizen upon arrival in the United States, their health tends to deteriorate the longer they remain in the country according to Unhealthy Assimilation and Demography statement made in May 2006)

Women were more likely than men to forgo their needed health care due to cost-related access barriers. according to the Commonwealth Fund statement in 2007. Women’s right to non-discrimination had been violated by increasingly restricting those services to women who needed reproductive health care. Health care is a right and not a commodity that only rich whites can enjoy. 

What is happening in 2017?

There is something to be said for the concept that excessive government is a bad thing. High taxes and burdensome regulations can hold back economic growth. Some will say that Aid programs can make people dependent on government and reduce the incentive for people to work hard.

As an institution that receives revenue from taxes rather than from providing goods and services that consumers actually want, the government has little reason to spend money efficiently. Unlike private businesses, the government will keep collecting revenue whether it does a good job or not.

Republicans have been successfully making this argument for decades. Even in 2017, it has been  an argument that has put them in a dominant position at all levels of government. Americans in fact, should be thanking President Obama in particular for doing so much to help them achieve some success in helping those in need of health care. Obamacare, after all, had come to represent the ultimate example for so many conservatives of government that is out of control.

And President Trump, while hardly a traditional Republican candidate, spent much of his campaign decrying Obamacare as one of the ultimate evils of the universe. That gives support for that old adage—the pot calling the pan black.

Ever since the Affordable Care Act became law, conservatives complained about the new regulations that it placed on insurance companies, increased health care costs, higher government spending resulting from Medicaid expansion and new subsidies, and the hated individual mandate that would impose penalties on people who did not get insurance. As a general rule, they prefer a health care system that is run by the private sector as much as possible, with competition between insurance companies and medical service providers supposedly creating more choices for consumers and driving prices down. They also question the idea that health care is some sort of a human right that government must provide rather than a service that individuals must pay for themselves.

As an aside, I remember when many years ago, Canadians had to pay a relatively low fee to get government-sponsored health benefits for themselves and their families.  We didn’t really complain because it provided a large amount of benefits including hospital and medical doctor’s fees.

Donald Trump as a candidate made some of these traditional conservative arguments, complaining particularly about new regulations, higher health care costs, and the hated individual mandate. He did not, however, emphasize the argument that people should buy health care for themselves. Instead, he claimed that a better law would be crafted that would keep the more popular parts of Obamacare, such as guaranteeing insurance for people with preexisting conditions and allowing young people to stay on their parent's insurance until the age of 26, and would not cause anyone to lose their insurance. In fact, he even claimed that more people would get affordable insurance than under Obamacare. It would be the perfect plan.  It would certainly make most Americans happy since they  would get more benefits with the government spending less money and imposing fewer rules. Is that his plan in 2017?

For someone who was supposedly not a traditional politician, Donald Trump played the ultimate political game better than the seasoned politicians. He promised the moon while being vague on the details of how Americans will get there. The only problem is that those seasoned politicians who have to write actual legislation know that the Trump’s plan is a fantasy, and it's a fantasy that they are not even interested in trying to deliver.

This is why the health plan recently passed by the House will cause millions to lose their insurance. So whether you agree with the conservative ideology or not, you can at least respect House Republicans for being consistent. It is President Trump, as has often been the case during his first few months in office, who is being inconsistent. After promising that no one would lose their insurance or be denied due to preexisting conditions, he has endorsed a plan that would do both.

If something resembling the House health care bill got through Congress and landed on the President's desk, Americans will find out what Donald Trump actually believes about health care.

Is it his priority to shrink the role of government or to provide affordable health care? And if he does go along with traditional conservatives and signs a bill that causes large numbers of people to lose their current insurance, what will his supporters think? Will they be happy simply because the hated Obamacare is gone, or will they be disappointed when they eventually realize that they were naive enough to believe in his fantasy?

President Trump, after failing to repeal the Affordable Care Act in Congress, decided to act on his own to relax health care standards on small businesses that band together to buy health insurance and may take steps to allow the sale of other health plans that skirt the health law’s requirements.

Trump plans to sign an executive order to promote health care choice and competition at a White House event attended by small-business owners and others.

It is possible is that Americans are not going to get a good health care plan at all. The House created a Bill so his Republicans could get it through the Senate. The Republican majority is slim in the Senate, and Senators have to think about public opinion throughout their states, not just the constituents of heavily gerrymandered districts. So when the Senate fails to come up with something that can be reconciled with the House, Republican members of the House can tell their constituents that they tried, Republican Senators can blame Democrats for standing in the way of change, and President Trump can then do what he does best—blame everyone but himself for the nation's continuing problems. The best news for President Trump and the GOP, of course, is that they will not have to deal with the wrath of millions of people who have lost their health insurance, and if Republicans are ever unhappy about any of the complex, inevitable problems associated with health care, they will still have the evil Obamacare to blame.

Although Trump has been telegraphing his intentions for more than a week, Democrats and some state regulators are now looking at Trump’s  intentions with increasing alarm, calling it another attempt to undermine President Barack Obama’s signature health care law. They warn that by relaxing standards for so-called association health plans, Mr. Trump would create low-cost insurance options for the healthy, driving up costs for the sick and destabilizing insurance marketplaces created under the Affordable Care Act.

There are concerns that the Trump administration intends to loosen restrictions on short-term health insurance plans that do not satisfy requirements of the Affordable Care Act.

His plan would cut off healthy individuals, and cannibalize the insurance exchanges. This could leave older, sicker people left behind in plans regulated under the Affordable Care Act since premiums could increase to the extent that they couldn’t pay them.

Large employer-sponsored health plans are generally subject to fewer federal insurance requirements than smaller group plans that have coverage purchased by individuals and families on their own. They are generally not required to provide “essential health benefits,” such as emergency services, maternity and newborn care, mental health coverage and substance abuse treatment, however, many do.

Several states considered bringing in Bills to treat health plans offered to small employers through a trade association as large-group coverage, exempt from federal rules that apply to small businesses. But the Obama administration blocked those efforts, saying they were pre-empted by the Affordable Care Act. Trump administration officials are reconsidering that interpretation, in view of the president’s vow to increase access to less expensive insurance.

Large-group plans are still subject to some requirements of the Affordable Care Act. They generally must cover children up to age 26 on their parents’ plans, cannot impose lifetime limits on covered benefits and cannot charge co-payments for preventive services like mammograms and colonoscopies. However, they are generally exempt from the requirements to provide a specified package of benefits and to cover a certain percentage of the cost of covered services.

The Trump administration is also looking for ways to ease restrictions on short-term health insurance plans that do not meet requirements of the Affordable Care Act. Under a rule issued last October by the Obama administration, the duration of such short-term plans, purchased by hundreds of thousands of people seeking inexpensive insurance, must be less than three months. The rules previously said “less than 12 months.

The Obama administration had said that some insurers were abusing short-term plans and keeping healthier consumers out of the Affordable Care Act marketplaces. People were buying these short-term plans as their “primary form of health coverage,” and some insurers were pitching their products to healthier people.

But Trump administration officials have said that with the insurance premiums soaring in many states, consumers should be able to buy less comprehensive, less expensive coverage as an alternative to conventional plans. The U.S. Chamber of Commerce said short-term policies will serve an important purpose for consumers who are between jobs. That sounds OK to me if the plan works.

Trump’s plan has some insurance experts worried. The influx of a set of plans exempt from the Affordable Care Act rules will essentially divide the market and make it increasingly unstable, according to Rebecca Owen, a health research actuary with the Society of Actuaries.

People who want or need broad coverage could find it increasingly difficult to obtain an affordable policy, according to Health Care experts While the administration’s goal may be to give people a broader choice of plans, it could have the opposite effect on people who need or want the robust coverage available under the Affordable Care Act and can’t afford it or even have access to it.

It is obvious that the easier you make it possible not to buy comprehensive coverage, the harder it will to buy comprehensive coverage later.

Meanwhile while, apprehensive health insurers wait for details of the executive order, they are still offering coverage in the online marketplaces created by the health care law.

Some Americans may already be attracted to short-term plans because of their low costs. These plans tend to limit benefits or offer policies only to people who do not have expensive medical conditions. Further, once they are in the plans, the rates may very well increase considerably.

Those insurers are most jittery about the possibility of a surge in short-term plans. Many of the large national insurers, like UnitedHealth Group, already offer these plans, and there would be little difficulty in their introducing more because of the executive order.

Short-term policies do not satisfy the coverage requirements of the Affordable Care Act, so consumers who buy them may be subject to tax penalties. But with the price of conventional insurance policies rising at double-digit rates, some people say they are willing to pay a penalty so they can buy a cheaper plan.

The introduction of the new plans could take much longer to come into being according to insurers and other experts. The administration would need to work out the regulatory details, and groups would need to reconstruct those plans.

However,  these plans pose some of the same risks, and industry experts have warned since that they have a history of leaving consumers with unpaid medical bills if they are not adequately regulated.

While association health plans can be well run, they have had a spotty track record.  In the past, some plans failed because they did not have enough money to pay their customers’ medical bills, while some insurance companies were accused of misleading people about exactly what the plans would cover.

Most of this info I got from reading an article written by Peter Pear and others.

How does the proposed America health care plans compare with those in Canada?

Once again Canadians across the country have looked across the border in disbelief as to how Americans just can’t seem to come to grips with their opinions that medical care is a right for everyone, not just those who can afford it. Many Americans also resist the idea that providing medical care is a collective responsibility whether it be for someone who has been in a car accident or diagnosed with breast cancer.

In Canada, we all pitch in to the costs of operating our health care plans through our taxes so doctors, nurses, hospital beds and MRI machines etc., are there for all of us when we need them. We don’t have to pay a cent for these services.

In Canada, we can decide to go to the ER of our choice and not have to even think about how much it will cost so we will get the treatment health professionals decide we need rather than what an insurance company deems we need.

In Ontario, our health needs and care are provided by the Ontario Health Insurance Plan (OHIP) People in Ontario don’t have to pay a cent for that coverage.

Many years ago, a woman I knew was suffering from what appeared to be inoperable cancer in the middle of her brain.  The surgeons told her that it was impossible to operate in that part of her brain without causing irreparable damage to her brain so they refused to operate.

She told me that she learned of a hospital in Sweden that does such operations with success by using a thin laser beam. She also said that she would have to be in the hospital for at least a month so that they can begin the procedure after fully examining her brain and planning the route that the laser beam will enter her brain.

She told me that she was told that the operation and the stay in the hospital would cost her $400,ooo dollars CAD. Naturally, she couldn’t afford that kind of money. She contacted OHIP and they refused to fund the operation. She then came to me and I convinced OHIP to pay for the operation, the hospital and the trip.  Her operation in Sweden was a success.

In 1999, when I was 66 years of age, I had a heart attack. I was in really bad shape. Of my four arteries feeding my heart, one was blocked 45% the second one was blocked 90%, the third, 90% and the fourth one, 99%. Of course, I had a heart operation. The three-month stay in the hospital, the large number of tests and the operation cost me nothing—not a cent.

Despite the operation, I have been living with only 27% of my heart functioning. For this reason, I had another two heart attacks  which resulted with me spending more months in the hospital. Further since I am obviously older than 59, all my medicine which is given to me from my local pharmacy and delivered by courier are given to me without having to pay a cent. If I had to pay for my medicine each month, I would have to pay at least a hundred dollars a month. OHIP also pays for my visits to my doctors, be they family doctors or specialists.   

Are Canada’s health plans superior to those of the United States? Let me give you an answer in a way that you will appreciate by asking you a question.

Is it the moon that raises our tides on Earth?