Doctors do very well here in Canada, but not as well as they do in the States. And yes, quite a few move to the States simply to earn more money. My uncle was one of them.
It happens with a lot of other careers too. We call it the "brain drain." Or at least we did a decade or so ago when it was in the news.
Given that we have a shortage of doctors here, and how expensive it is to train them, it would be nice if doctors who trained in Canada actually stayed in Canada.
I get to call my hours, as well as my rates. I really focus on building my skillset to a level where I can work as quickly and efficiently as possible, while turning out ever-better quality for my clients. I do this not to be able to keep jam-packing my workday, but to be able to have a lot of free time to myself, to relax and learn new skills (cooking, playing the piano).
Through a system of living frugally, and working efficiently, I've found myself doing as well financially as many of my friends and college alum working up to 60 hour work weeks, when I'm just down in the 30's (sometimes less!). And in the end I feel like I'm a lot less of a worrywort and more upbeat on life after college than they are.
I'd say I'm pretty happy working this many hours a week, and I hope to continue being paid better and better for my wares.
Maybe what we need to do is think about piecewise solutions.
1) Everyone should be able to afford basic preventive services--it would be great if more people "took advantage" of the system to get their kids immunized, teeth cleaned regularly, etc.
2) Everyone should be able to join negotiation guilds to work out prices for the usual illnesses and so forth.
3) Everyone should be able to spread out the risk of catastrophic illnesses or accidents.
4) We should encourage drug innovation (including basics like immunizations and antibiotics) without putting appropriate pharmacology out of the reach of patients.
To my mind, (1) is a perfect candidate for government universal coverage. I think the uninsured often don't "take advantage" of the system as avoid the system as long as they can; this would be more efficient and save paperwork.
For (2), maybe more like the current system, except set up options that do not rely on being employed by a big company. Make it just like joining Costco or something. Make your coverage as portable as your cell phone number, not just the limited time that COBRA allows. Middle class people can budget and price shop and whatever; the poor are on medicaid anyway. It is my understanding that with a lot of welfare programs it's more expensive to track down a few "abusers" than to just let them draw the check; I would imagine that it would be just as true here, especially since people don't go to the doctor to make money. (Well, unless they're drug reps....)
For (3), the private sector might be able to handle this if they were absolutely forced to cover people for the same price except for maybe smoker/non-smoker and maternity differentials. Even better, to my mind, would be a sliding scale, but that won't happen. The point is to actually pool the risk; it's not much of a pool if you slice it so fine that each pool is just a droplet.
I'm not sure what we can do about (4), but it's worth thinking about how to promote scientific research in general.
I'm a little torn on the issue of malpractice insurance. There are definately instances in which doctors are forced to pay WAY too much for coverage, but isn't the average cost for a doctor around $25K per year? High, but not insurmountable. I think OB/Gyns pay the highest rate, and at the worst, it's a quarter million per year. Unless I'm getting the figures wrong.
It's true that there are many doctors in the US who went to school in Canada - my father is one of them. He didn't move here for the money, although it's a nice living. He happened to meet my mother when doing his internship in Los Angeles, and they decided to raise us here. Mind you, there are doctors from all over the world practicing here in the United States - it's probably a combination of wanting to make a really good salary and wanting to work with some of the best research facilities and with some very good technology.
Kelja, I think you're making some very broad generalizations about how Canadians view health care. I get the impression you think everything is handed to us for free and we take it for granted. Let me tell you a little more about what our health care is like.
Resources aren't exactly plentiful up here. There's a significant portion of the population who can't find a family doctor at all, and it really does take 6 - 9 months to get in to see a specialist. Wait times for non-emergency services are ridiculous as well. If you have a family doctor, sometimes it can be weeks before you can get in to see him or her. Emergency room wait times are getting better, but they still aren't ideal. It can take a while to even get booked for a test because of high demand. Private hospital rooms aren't free either.
You're wrong when you say that we're wasteful or careless or don't take personal responsibility because our health care is "free". As you argue, people may be careless with resources they don't take ownership for, but you're forgetting that people are MORE careful with resources that are limited.
In addition, I think people who pay more for something have an inflated sense of what they are entitled to. The whole "I worked hard for it, therefore I deserve" it attitude is part of what got the US into its current financial crisis in the first place.
I have heard, although this is admittedly only anecdotal, that some Canadian med school graduates actually move to the U.S. for that very reason. It simply isn't profitable (or as profitable) to work in Canada.
“People in emergency situations simply can't be debating price and many times are not even able to decline procedures.”
So what about non-emergency situations? And who is it that is unable to decline procedures? Are you specifically referring to situations in which the patient is incapacitated and loved ones have not arrived or do you believe there are other situations in which patients are incapable of making their own care decisions?
“…it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.”
Perhaps I’m insensitive here, but optimizing my physical and financial wellbeing far outweighs a doctor’s personal upset over a cost inquiry. Doctors are human beings too, often with financial problems of their own (btw, how is it that malpractice insurance has escaped us completely in this debate?), who surely are capable of being reasonable about a patient’s financial concerns. I’m not sure I’d stick with a doctor who made me feel uncomfortable with such an inquiry.
“There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.”
I’ve got to say, this is fantastic news to me. I didn’t realize that there were any providers like that, but I would love to consider one as an option. The fact that they even exist is a positive for me, an indication that we’re moving toward price transparency.
And, while I agree with your treatment on drug company ads (and wonder to myself how they can possibly sell drugs given their outrageous potential side effects), I can’t blame them completely because their “for profit” nature has resulted in some fantastic benefits to our levels of health care. We must defend the little guy without blaming it all on the big guy just because it’s easy.
It seems to me that most of us agree that price transparency needs to increase. I’m curious, though, to hear from those who believe in socialized health insurance. How, in your view, will price transparency increase? I just don’t see that happening with the government in charge. Don’t forget, that just because the government becomes the insurer does not necessarily mean that the drug companies or various PACs go away. In fact, I’d bet they’d increase their efforts to ensure that their constituents’ needs are addressed. Goodness knows Uncle Sam is not the greatest at transparency and efficiency.
In my view two very bad things could come out of socialized health care. Either (a) we have a total lack of price transparency leading to increased usage by people who aren’t personally paying and are therefore more likely to use it or (b) we end up waiting 9 months for an MRI and the rich leave the US to go where they can get the MRI. Seems to me that the poor, who cannot afford to travel for healthcare, are still stuck out in that situation.
I think doctors will be resistant to the change, too. I doubt a doctor in Canada makes $300K-500K a year like some physicians do here, unless they are a surgeon specializing in very expensive procedures. Even THEN, I don't think doctors make that much.
Not that the money is the only reason doctors become doctors, understand. But I imagine it might play a role in the fight for or against socialization.
I agree completely, btw, on the idea that consumers need a more transparent system so customers can make choices. It's obviously only a part of the solution, but it would be helpful.
I think the doctors are no longer much resisting moves toward "socialized" medicine.
They used to, because they didn't want some government official telling them what care to provide and what care to withhold, based on price.
But now the guy is there anyway. He's not a government official--he works for the insurance company--but he's there, and he's telling the doctors what they can and can't do. And the doctors have to listen--to do otherwise would be to bankrupt their institution (if they didn't get fired first).
So, I think the doctors are on board. (The hypothetical guy from the government is not going to be worse than the guy they've already got from the insurance company.)
The only people left in opposition are the insurance companies. They're the ones whose profit is on the line. Under a single-payer system, they'd be cut out completely. Under a system where they had to write insurance for everyone (including sick people), their profits would be squoze (although not necessarily badly, as long as the rules applied to all the other insurance companies, too).
You're right, by the way, that it makes perfect sense to trust the doctor to provide good care without knowing that you can trust his institution to charge fair prices--although I still think that's a symptom that needs other fixes than simply encouraging individual consumers to be more price aware. At the point where they need to make a decision on care, they're simply not in a position to shop around. The shopping around needs to come earlier in the process. (In the choice of institution, the choice of insurance company, and by the insurance company when they negotiate rates.)
I have done the same thing. I used to be a middle finger driver doing 85+ on the highway. Now I do 62-63 with cruise control in the right lane and get 26mpg instead of 20mpg. That is over 25% improvement. My commute is only 13 miles one way, 11 of which are highway miles so the time difference is two and a half minutes each way. That's five minutes a day. I think I can live with that.
26 mpg at $4/gallon is like 20mpg at $3.07/gallon.
"And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price."
Might seem bizarre, but if you think it about it, it's not the doctor who generally charges you - it's the institution that he or she works for. So doctors frequently have no idea what a procedure is going to cost - that's handled by an entirely different department. And anyway, even if a doctor did know the prices, he or she would be more apt to worry about providing good care than charging you correctly - they can get sued for malpractice if they mess up your operation, but whoever heard of a doctor getting sued for charging more than they should for a suture?
I think that whoever said that we're both pushing the cost along to someone else is correct. Someone always ends up paying. Both systems have serious sets of flaws.
I think the main thing that would prevent the American system from socializing is the American Medical Association - they have a powerul lobbying system that tried to sabotage Canada's socialization so many decades ago. They may have failed up north, but I'm sure they'd do well by appealing to the American sense of individualism.
One more thing I would add. Some times the cruise control can really impair your MPG especially if you have to drive up steep elevations or hills all the time. Instead try slowing down on hills and speeding up when descending. Obviously don't go so slow that you start doing 15 MPH or speed up to the point where you do 100 MPH. Instead use the gas and stay off the brake as much as possible. Engine braking is a wonderful thing as well. Don't race up to a red light instead let your car coast for a while.
Just some extra things I noticed could save you a little bit of money.
Rather than rescinding coverage, the FDIC just closes the bank down. (They didn't used to be able to do that. But since the early 1990s, they can close the bank down even before it's insolvant, if its capital gets too low.)
Also, the money they use to pay off insured claims is not taxpayer money. The FDIC is funded by fees paid by the insured banks. They can borrow money from the Treasury, if necessary (which means that the taxpayer is potentially on the hook if the insurance fee doesn't cover all the costs of paying off the insured depositors), but so far they have always paid the Treasury back for any such borrowing. Gory details here: http://www.fdic.gov/bank/historical/brief/brhist.pdf
The real danger is not the occasional bad bank--the system handles those well. The danger is systemic problems, such as the current credit crisis, where everybody was making the same mistakes, and they all go bad at once. (The system is designed for situations where everyone is making their own mistakes, so only a handful go bad at any particular time.)
How I made money is over "Free after Rebate" on Amazon, mostly yearly update software. For example, two months before Norton 2009 is out, Norton 2008 must have a huge price cut, combining coupon and it becomes free! You load them up with your home addr, your work addr, your parents addr to break the rebate limit. Then you list these things out on eBay once the promotion is over.
Another example is TurboTax and TaxCut. The biggest discount you can get is around Thanksgiving. The publisher desperately wants to cash in early profits while the majority folks are not in the tax mood. You usually can see deals like buy TurboTax get a free Norton and a free Quicken. Guess what? You load them up and sell in February!
i had the same experience: i grew up in a small, poor town in sodak. the few *lucky* kids who had new clothes every year didn't wear them often because they would be made fun of for having new.
my years in college were enough for me to figure out that i wanted to live in rural america my whole life. the girls in my freshman dorm had excess everything - cars, clothing, money - while i was just about the only one who worked and went to school. i can't imagine the kind of pressure they had felt their entire lives to "keep up with the jones" while i was fortunate to had never experienced that until i was 18.
sure there are "jones" here - but they are few and far between - i like to think that makes it easier to not keep up with them :)
Two weeks ago we decided to take a trip from Raleigh to D.C. - typically a 4-1/2hr trip. I was frustrated because of the price of gas. I decided to check out the MPG in my car at various speeds. Using my car's trip computer I discovered that at 65mph (the posted speed) I was averaging 29 MPG in my Scion xB. At 55mph I averaged 42 MPG !!!
After our trip, I returned to my daily 1.5hr commute (each way) and have adopted the 55mph / Right Lane driving habit. I am considering getting a magnetic sign made for the rear hatch that states
29mpg @ 65mph / 42mpg @ 55mph
DO THE MATH!!!
The point of price transparency in a for profit system really is a major issue. Most people do not have adequate enough insurance that they can simply ignore the initial price of their health care. Many don't have insurance and most programs find ways to dump a large portion of the financial burden back on the patient.
About 50% of those filing for bankruptcy do so because of medical bills, most of those people had insurance.
People in emergency situations simply can't be debating price and many times are not even able to decline procedures. There are very few situations where you can realistically inquire about prices. Even in those situations it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.
There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.
Now add to this the rampant disease mongering by drug companies and some providers, this increases their profits but mostly add to the financial burden of patients. I heard one this morning that said "if your listening to this your at risk for heart disease" and went on to try to sell expensive cardiovascular testing. There was a news piece yesterday, now the drug companies are trying to convince people that young kids need expensive statin drugs for their cholesterol. This is really a seperate issue compared to how broken our for profit medical system is that bankrupts people daily. But at some point either way the lack of transparency and disease mongering has to stop, it is just adding to the financial burden of all of us.
The Kaiser Family Foundation found that among those with coverage provided through employers, the average premium was $4500/year, and the average "family plan" premium was $12000. The amount paid by the employee was on average $700/year, or $3300 for a family, with the employer paying the balance.
Note that these are averages, and do not count co-pays, etc.... Those who follow the tradition of self-employment, of course, pay the entire premium, and often don't get the premium discounts and completeness of coverage that other-employed individuals do.
I'm sure you're right to an extent--part of the high cost of medicine is that people don't care if they get the expensive option or the cheap one, because it doesn't come out of their pocket. I don't think that's the biggest factor, though.
I think the biggest factor in the general rise of health care costs is that the care is much, much better than it was, let's say, 50 years ago. Things like drugs for high blood pressure, statins, bypass surgery, stents, and angioplasty have added years to millions of people's lives--often years of high-quality, active life. Some cancers can be virtually cured now. Many other conditions that used to kill people can be cured--and other conditions that merely made them miserable can at least be treated.
I think the much better care is worth paying for. Maybe not quite as much as it costs in the US, but a lot. I'm willing to budget for that care. I'm just bugged that it's so hard to get insurance to protect me from the small risk that I'll be the one who ends up needing care costing tens or hundreds of thousands of dollars (unless I want to work full-time at a good job).
I am fully aware of the situation in the country. The problem is too many people like you who think everything is about you and your money.
People with that mindset think that way until something bad happens to them and reality hits them right in the face. Then they are the loudest ones demanding they be given theirs by everyone else because they earned it in some regard.
When we put money ahead of the well being of other people and our country we take another step away from being human.
Have you ever gone to the doctor when you were really sick or after having been seriously injured? There's no way that somebody, even with something minor like a dislocated finger, is going to say, "No, no--don't reduce that fracture until I call around and see if you're giving me a good price." If you're suffering, and a doctor you trust to provide good care is there offering it, you're going to take it. (And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price.)
That's not to say that the issue you bring up is invalid--it is. And being a little proactive is not just good financial sense; it's also good for your health. An unnecessary MRI is mostly just an expense, but an unnecessary CAT scan exposes you to a bunch of radiation and an unnecessary biopsy to all the hazards of surgery. Well worth avoiding that.
The time to shop around, though, is not when you're bleeding or infected. The time to shop around is up-front, when you're deciding who to get health care from. And that's exactly what the insurance companies do when they negotiate rates from health care providers. But, as I've said before, if you can't get insurance, you can't get in on the negotiated rates--you're doubly screwed.
Andrea,
Doctors do very well here in Canada, but not as well as they do in the States. And yes, quite a few move to the States simply to earn more money. My uncle was one of them.
It happens with a lot of other careers too. We call it the "brain drain." Or at least we did a decade or so ago when it was in the news.
Given that we have a shortage of doctors here, and how expensive it is to train them, it would be nice if doctors who trained in Canada actually stayed in Canada.
I get to call my hours, as well as my rates. I really focus on building my skillset to a level where I can work as quickly and efficiently as possible, while turning out ever-better quality for my clients. I do this not to be able to keep jam-packing my workday, but to be able to have a lot of free time to myself, to relax and learn new skills (cooking, playing the piano).
Through a system of living frugally, and working efficiently, I've found myself doing as well financially as many of my friends and college alum working up to 60 hour work weeks, when I'm just down in the 30's (sometimes less!). And in the end I feel like I'm a lot less of a worrywort and more upbeat on life after college than they are.
I'd say I'm pretty happy working this many hours a week, and I hope to continue being paid better and better for my wares.
Wow, 80 hours of overtime a month?
Isnt that only a 60 hour work week? I should be so lucky
and honestly thats not a whole lot
Do you think that we might go back to the 70's and have a 55mph speed limit? There would be many benefits.
Maybe what we need to do is think about piecewise solutions.
1) Everyone should be able to afford basic preventive services--it would be great if more people "took advantage" of the system to get their kids immunized, teeth cleaned regularly, etc.
2) Everyone should be able to join negotiation guilds to work out prices for the usual illnesses and so forth.
3) Everyone should be able to spread out the risk of catastrophic illnesses or accidents.
4) We should encourage drug innovation (including basics like immunizations and antibiotics) without putting appropriate pharmacology out of the reach of patients.
To my mind, (1) is a perfect candidate for government universal coverage. I think the uninsured often don't "take advantage" of the system as avoid the system as long as they can; this would be more efficient and save paperwork.
For (2), maybe more like the current system, except set up options that do not rely on being employed by a big company. Make it just like joining Costco or something. Make your coverage as portable as your cell phone number, not just the limited time that COBRA allows. Middle class people can budget and price shop and whatever; the poor are on medicaid anyway. It is my understanding that with a lot of welfare programs it's more expensive to track down a few "abusers" than to just let them draw the check; I would imagine that it would be just as true here, especially since people don't go to the doctor to make money. (Well, unless they're drug reps....)
For (3), the private sector might be able to handle this if they were absolutely forced to cover people for the same price except for maybe smoker/non-smoker and maternity differentials. Even better, to my mind, would be a sliding scale, but that won't happen. The point is to actually pool the risk; it's not much of a pool if you slice it so fine that each pool is just a droplet.
I'm not sure what we can do about (4), but it's worth thinking about how to promote scientific research in general.
I'm a little torn on the issue of malpractice insurance. There are definately instances in which doctors are forced to pay WAY too much for coverage, but isn't the average cost for a doctor around $25K per year? High, but not insurmountable. I think OB/Gyns pay the highest rate, and at the worst, it's a quarter million per year. Unless I'm getting the figures wrong.
It's true that there are many doctors in the US who went to school in Canada - my father is one of them. He didn't move here for the money, although it's a nice living. He happened to meet my mother when doing his internship in Los Angeles, and they decided to raise us here. Mind you, there are doctors from all over the world practicing here in the United States - it's probably a combination of wanting to make a really good salary and wanting to work with some of the best research facilities and with some very good technology.
Kelja, I think you're making some very broad generalizations about how Canadians view health care. I get the impression you think everything is handed to us for free and we take it for granted. Let me tell you a little more about what our health care is like.
Resources aren't exactly plentiful up here. There's a significant portion of the population who can't find a family doctor at all, and it really does take 6 - 9 months to get in to see a specialist. Wait times for non-emergency services are ridiculous as well. If you have a family doctor, sometimes it can be weeks before you can get in to see him or her. Emergency room wait times are getting better, but they still aren't ideal. It can take a while to even get booked for a test because of high demand. Private hospital rooms aren't free either.
You're wrong when you say that we're wasteful or careless or don't take personal responsibility because our health care is "free". As you argue, people may be careless with resources they don't take ownership for, but you're forgetting that people are MORE careful with resources that are limited.
In addition, I think people who pay more for something have an inflated sense of what they are entitled to. The whole "I worked hard for it, therefore I deserve" it attitude is part of what got the US into its current financial crisis in the first place.
Andrea / Canada Girl:
I have heard, although this is admittedly only anecdotal, that some Canadian med school graduates actually move to the U.S. for that very reason. It simply isn't profitable (or as profitable) to work in Canada.
Is that the case in your opinions?
@Lucille:
“People in emergency situations simply can't be debating price and many times are not even able to decline procedures.”
So what about non-emergency situations? And who is it that is unable to decline procedures? Are you specifically referring to situations in which the patient is incapacitated and loved ones have not arrived or do you believe there are other situations in which patients are incapable of making their own care decisions?
“…it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.”
Perhaps I’m insensitive here, but optimizing my physical and financial wellbeing far outweighs a doctor’s personal upset over a cost inquiry. Doctors are human beings too, often with financial problems of their own (btw, how is it that malpractice insurance has escaped us completely in this debate?), who surely are capable of being reasonable about a patient’s financial concerns. I’m not sure I’d stick with a doctor who made me feel uncomfortable with such an inquiry.
“There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.”
I’ve got to say, this is fantastic news to me. I didn’t realize that there were any providers like that, but I would love to consider one as an option. The fact that they even exist is a positive for me, an indication that we’re moving toward price transparency.
And, while I agree with your treatment on drug company ads (and wonder to myself how they can possibly sell drugs given their outrageous potential side effects), I can’t blame them completely because their “for profit” nature has resulted in some fantastic benefits to our levels of health care. We must defend the little guy without blaming it all on the big guy just because it’s easy.
It seems to me that most of us agree that price transparency needs to increase. I’m curious, though, to hear from those who believe in socialized health insurance. How, in your view, will price transparency increase? I just don’t see that happening with the government in charge. Don’t forget, that just because the government becomes the insurer does not necessarily mean that the drug companies or various PACs go away. In fact, I’d bet they’d increase their efforts to ensure that their constituents’ needs are addressed. Goodness knows Uncle Sam is not the greatest at transparency and efficiency.
In my view two very bad things could come out of socialized health care. Either (a) we have a total lack of price transparency leading to increased usage by people who aren’t personally paying and are therefore more likely to use it or (b) we end up waiting 9 months for an MRI and the rich leave the US to go where they can get the MRI. Seems to me that the poor, who cannot afford to travel for healthcare, are still stuck out in that situation.
I think doctors will be resistant to the change, too. I doubt a doctor in Canada makes $300K-500K a year like some physicians do here, unless they are a surgeon specializing in very expensive procedures. Even THEN, I don't think doctors make that much.
Not that the money is the only reason doctors become doctors, understand. But I imagine it might play a role in the fight for or against socialization.
I agree completely, btw, on the idea that consumers need a more transparent system so customers can make choices. It's obviously only a part of the solution, but it would be helpful.
I think the doctors are no longer much resisting moves toward "socialized" medicine.
They used to, because they didn't want some government official telling them what care to provide and what care to withhold, based on price.
But now the guy is there anyway. He's not a government official--he works for the insurance company--but he's there, and he's telling the doctors what they can and can't do. And the doctors have to listen--to do otherwise would be to bankrupt their institution (if they didn't get fired first).
So, I think the doctors are on board. (The hypothetical guy from the government is not going to be worse than the guy they've already got from the insurance company.)
The only people left in opposition are the insurance companies. They're the ones whose profit is on the line. Under a single-payer system, they'd be cut out completely. Under a system where they had to write insurance for everyone (including sick people), their profits would be squoze (although not necessarily badly, as long as the rules applied to all the other insurance companies, too).
You're right, by the way, that it makes perfect sense to trust the doctor to provide good care without knowing that you can trust his institution to charge fair prices--although I still think that's a symptom that needs other fixes than simply encouraging individual consumers to be more price aware. At the point where they need to make a decision on care, they're simply not in a position to shop around. The shopping around needs to come earlier in the process. (In the choice of institution, the choice of insurance company, and by the insurance company when they negotiate rates.)
Thanks for taking the time to write this, Philip. I think it's one of my favorite articles on Wise Bread so far.
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I have done the same thing. I used to be a middle finger driver doing 85+ on the highway. Now I do 62-63 with cruise control in the right lane and get 26mpg instead of 20mpg. That is over 25% improvement. My commute is only 13 miles one way, 11 of which are highway miles so the time difference is two and a half minutes each way. That's five minutes a day. I think I can live with that.
26 mpg at $4/gallon is like 20mpg at $3.07/gallon.
"And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price."
Might seem bizarre, but if you think it about it, it's not the doctor who generally charges you - it's the institution that he or she works for. So doctors frequently have no idea what a procedure is going to cost - that's handled by an entirely different department. And anyway, even if a doctor did know the prices, he or she would be more apt to worry about providing good care than charging you correctly - they can get sued for malpractice if they mess up your operation, but whoever heard of a doctor getting sued for charging more than they should for a suture?
I think that whoever said that we're both pushing the cost along to someone else is correct. Someone always ends up paying. Both systems have serious sets of flaws.
I think the main thing that would prevent the American system from socializing is the American Medical Association - they have a powerul lobbying system that tried to sabotage Canada's socialization so many decades ago. They may have failed up north, but I'm sure they'd do well by appealing to the American sense of individualism.
Also, our fear of high taxes.
One more thing I would add. Some times the cruise control can really impair your MPG especially if you have to drive up steep elevations or hills all the time. Instead try slowing down on hills and speeding up when descending. Obviously don't go so slow that you start doing 15 MPH or speed up to the point where you do 100 MPH. Instead use the gas and stay off the brake as much as possible. Engine braking is a wonderful thing as well. Don't race up to a red light instead let your car coast for a while.
Just some extra things I noticed could save you a little bit of money.
@Wilson:
Rather than rescinding coverage, the FDIC just closes the bank down. (They didn't used to be able to do that. But since the early 1990s, they can close the bank down even before it's insolvant, if its capital gets too low.)
Also, the money they use to pay off insured claims is not taxpayer money. The FDIC is funded by fees paid by the insured banks. They can borrow money from the Treasury, if necessary (which means that the taxpayer is potentially on the hook if the insurance fee doesn't cover all the costs of paying off the insured depositors), but so far they have always paid the Treasury back for any such borrowing. Gory details here: http://www.fdic.gov/bank/historical/brief/brhist.pdf
The real danger is not the occasional bad bank--the system handles those well. The danger is systemic problems, such as the current credit crisis, where everybody was making the same mistakes, and they all go bad at once. (The system is designed for situations where everyone is making their own mistakes, so only a handful go bad at any particular time.)
How I made money is over "Free after Rebate" on Amazon, mostly yearly update software. For example, two months before Norton 2009 is out, Norton 2008 must have a huge price cut, combining coupon and it becomes free! You load them up with your home addr, your work addr, your parents addr to break the rebate limit. Then you list these things out on eBay once the promotion is over.
Another example is TurboTax and TaxCut. The biggest discount you can get is around Thanksgiving. The publisher desperately wants to cash in early profits while the majority folks are not in the tax mood. You usually can see deals like buy TurboTax get a free Norton and a free Quicken. Guess what? You load them up and sell in February!
i had the same experience: i grew up in a small, poor town in sodak. the few *lucky* kids who had new clothes every year didn't wear them often because they would be made fun of for having new.
my years in college were enough for me to figure out that i wanted to live in rural america my whole life. the girls in my freshman dorm had excess everything - cars, clothing, money - while i was just about the only one who worked and went to school. i can't imagine the kind of pressure they had felt their entire lives to "keep up with the jones" while i was fortunate to had never experienced that until i was 18.
sure there are "jones" here - but they are few and far between - i like to think that makes it easier to not keep up with them :)
cheers -
Two weeks ago we decided to take a trip from Raleigh to D.C. - typically a 4-1/2hr trip. I was frustrated because of the price of gas. I decided to check out the MPG in my car at various speeds. Using my car's trip computer I discovered that at 65mph (the posted speed) I was averaging 29 MPG in my Scion xB. At 55mph I averaged 42 MPG !!!
After our trip, I returned to my daily 1.5hr commute (each way) and have adopted the 55mph / Right Lane driving habit. I am considering getting a magnetic sign made for the rear hatch that states
29mpg @ 65mph / 42mpg @ 55mph
DO THE MATH!!!
The point of price transparency in a for profit system really is a major issue. Most people do not have adequate enough insurance that they can simply ignore the initial price of their health care. Many don't have insurance and most programs find ways to dump a large portion of the financial burden back on the patient.
About 50% of those filing for bankruptcy do so because of medical bills, most of those people had insurance.
People in emergency situations simply can't be debating price and many times are not even able to decline procedures. There are very few situations where you can realistically inquire about prices. Even in those situations it is extremely difficult to obtain that information and it frequently sets up a hostile environment with the provider. Doctors and staff get their noses out of joint when people ask about costs or feel it is detracting from competent care.
There are some providers that have almost all procedures and tests including prices online or otherwise easily available to the public. These providers are very much in the minority.
Now add to this the rampant disease mongering by drug companies and some providers, this increases their profits but mostly add to the financial burden of patients. I heard one this morning that said "if your listening to this your at risk for heart disease" and went on to try to sell expensive cardiovascular testing. There was a news piece yesterday, now the drug companies are trying to convince people that young kids need expensive statin drugs for their cholesterol. This is really a seperate issue compared to how broken our for profit medical system is that bankrupts people daily. But at some point either way the lack of transparency and disease mongering has to stop, it is just adding to the financial burden of all of us.
The Kaiser Family Foundation found that among those with coverage provided through employers, the average premium was $4500/year, and the average "family plan" premium was $12000. The amount paid by the employee was on average $700/year, or $3300 for a family, with the employer paying the balance.
Note that these are averages, and do not count co-pays, etc.... Those who follow the tradition of self-employment, of course, pay the entire premium, and often don't get the premium discounts and completeness of coverage that other-employed individuals do.
@Kelja:
I'm sure you're right to an extent--part of the high cost of medicine is that people don't care if they get the expensive option or the cheap one, because it doesn't come out of their pocket. I don't think that's the biggest factor, though.
I think the biggest factor in the general rise of health care costs is that the care is much, much better than it was, let's say, 50 years ago. Things like drugs for high blood pressure, statins, bypass surgery, stents, and angioplasty have added years to millions of people's lives--often years of high-quality, active life. Some cancers can be virtually cured now. Many other conditions that used to kill people can be cured--and other conditions that merely made them miserable can at least be treated.
I think the much better care is worth paying for. Maybe not quite as much as it costs in the US, but a lot. I'm willing to budget for that care. I'm just bugged that it's so hard to get insurance to protect me from the small risk that I'll be the one who ends up needing care costing tens or hundreds of thousands of dollars (unless I want to work full-time at a good job).
I am fully aware of the situation in the country. The problem is too many people like you who think everything is about you and your money.
People with that mindset think that way until something bad happens to them and reality hits them right in the face. Then they are the loudest ones demanding they be given theirs by everyone else because they earned it in some regard.
When we put money ahead of the well being of other people and our country we take another step away from being human.
@Joanna:
Have you ever gone to the doctor when you were really sick or after having been seriously injured? There's no way that somebody, even with something minor like a dislocated finger, is going to say, "No, no--don't reduce that fracture until I call around and see if you're giving me a good price." If you're suffering, and a doctor you trust to provide good care is there offering it, you're going to take it. (And, frankly, it seems kind of bizarre to trust the doctor provide good care while not trusting him or her to charge a fair price.)
That's not to say that the issue you bring up is invalid--it is. And being a little proactive is not just good financial sense; it's also good for your health. An unnecessary MRI is mostly just an expense, but an unnecessary CAT scan exposes you to a bunch of radiation and an unnecessary biopsy to all the hazards of surgery. Well worth avoiding that.
The time to shop around, though, is not when you're bleeding or infected. The time to shop around is up-front, when you're deciding who to get health care from. And that's exactly what the insurance companies do when they negotiate rates from health care providers. But, as I've said before, if you can't get insurance, you can't get in on the negotiated rates--you're doubly screwed.