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Voters don’t give much thought to who runs their state department of insurance. But as key provisions of the new federal health law begin to take effect, the insurance commissioner will become the king of a much bigger kingdom.
Voters in four states, including Georgia and California, will directly elect an insurance chief on Tuesday. And in nearly three dozen other states, whoever is elected governor will name the commissioner.
Fame does not come easy to even the most heroic insurance commissioner. California’s current chief forced health plans to scale back double-digit rate hikes, and still he’s the white knight no one can name.
Steve Poizner is the California insurance commissioner, and whoever replaces him – and other insurance chiefs around the nation – could change your life.
“With the insurance market reforms, it’s really going to be important for states to take a proactive role in responding to any problems that come up and making sure plans are complying with the law,” says Sabrina Corlette, a health policy researcher at Georgetown University.
New Consumer Protections
She says that under the federal health law, state insurance chiefs will have a long list of new consumer protections to enforce. For example, starting in 2014, health plans can’t charge women or sicker people more.
They’re also helping to write the regulations for their own expanded powers. Congress left it up to an obscure group – the National Association of Insurance Commissioners – to essentially decide critical details, such as what health plans can claim as actual medical care vs. administration and profit.
Corlette says this decision made these humble regulators very popular with industry lobbyists at their spring meeting.
“I was stunned to discover that there were about 17 consumer representatives that were focused on health care, compared to over 1,000 different insurance industry representatives,” she says.
Consumer advocates and industry officials say once the rules are written, state regulators will have to crack down on health plans looking to exploit fuzzy rules or weak enforcement. At the same time, if they’re too heavy-handed, the plans might leave the market.
State Impact On Federal Health Overhaul
All of which means state insurance chiefs could very well play a key role in whether the federal health overhaul flies or flops. Laurie Sobel, a senior attorney with the consumer advocacy group Consumers Union, says it matters how the insurance commissioners view the new federal health law.
“If you have one that really doesn’t want to enforce it, then consumers are going to need to fight it every step of the way,” Sobel says.
The two candidates vying to become California’s chief regulator have starkly different views on how best to protect consumers. Assemblyman Mike Villines, the Republican in the race, is a skeptic about whether the government can fix a system he admits is broken.
“When you start to get into mandating behavior and you have to tell the insurance companies there are these for-sure things in here that you have to do – I think that Californians and the nation is not quite ready for that,” Villines says.
His opponent, Democratic Assemblyman Dave Jones, says the federal overhaul will offer critical protections and new choices to consumers.
“I plan to use the office both formally and informally, to take a very assertive role in terms of health insurance reform,” Jones says.
Bad News For Reformers?
Overseeing the national rule-writing effort is Kansas Insurance Commissioner Sandy Praeger. She’s up for re-election – a Republican in a solidly red state and running unopposed. With no challenger, she’s instead spending her time worrying about all the details her group must decide.
“I don’t want to get thrown under the bus,” Praeger says. “We don’t want to be blamed if this isn’t working. So we’ve got a huge responsibility to try to get it right.
But many Republican candidates for governor think the law is just wrong. And in some states, those candidates – who could end up appointing new insurance chiefs – want to repeal the federal health overhaul.
With Democrats on the ropes nationwide, that could be bad news for reformers.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/insurance/npr-insurance-commissioners/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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When Miles Owyang was born, six weeks premature, the doctors determined that he had a heart ailment. It was nothing serious, just something to monitor.
Today, Miles is a radiant 9-year-old and a fierce tennis and lacrosse player. Health insurance for him was never a problem until his parents, both Silicon Valley electrical engineers, lost their jobs and their employer-based insurance, and had to look for an individual family policy.
No insurer would accept Miles.
His mom, Tara Anderson, applied to join California’s high-risk pool. “They told us it will probably be about three months before he’s accepted,” she says.
The high-risk pools in most states are largely viewed as a failure. They were originally meant as insurers of last resort for those shut out of the private health insurance market, but according to the national association of state high-risk programs, the pools cover only about 200,000 Americans.
The California plan is capped at 7,100 members and often has a waiting list. Premiums and deductibles are wildly expensive, and the policies have spending caps that are frequently exceeded.
The new federal health care law sets aside $5 billion to fund new high-risk programs that are more affordable and open to more people.
Deborah Chollet, a health insurance expert at the nonpartisan research firm Mathematica, says people who apply to the new programs will pay a standard rate, or the rate they would pay for a policy if they did not have a pre-existing condition that excluded them from coverage.
“That is an enormous benefit,” she says. Medical charges for people in a high-risk pool could drop by as much as a third, and they will no longer face annual or lifetime caps, Chollet adds. A family would pay no more than $11,900 a year. Individuals would pay under $6,000 a year.
Enrollment rules will loosen as well. In some states, current applicants must prove that private insurers rejected them. Under the new law, anyone with a pre-existing condition who lacks coverage can join the program. The federal government will define what those conditions are, but they are likely to be the same long list used by insurers, including cancer, diabetes, heart disease and even pregnancy.
“My sense is they’re going to let people in under all reasonable circumstances … if someone has made every effort to maintain coverage, they would be eligible for this,” Chollet says. She adds that 1 million to 2 million people could gain coverage under the federally financed program.
Some of the $5 billion federal allocation will likely go straight to states to expand their pools. However, about 15 states don’t have high-risk pools, and others would have to change their laws to qualify for the funds. The federal government will likely also offer a national pool.
Still, Lesley Cummings, director of the California Major Risk Medical Insurance Program, the state’s high-risk pool, says she has far more questions than answers about the new program. “We don’t yet know the details of how it will work, and are eager to talk about this with our federal colleagues,” Cummings says.
The federal government has begun reaching out to states, to gauge their interest in starting or expanding coverage for the medically uninsurable. States have until the end of this month to submit an application.
The law says these new high-risk pools must be implemented by mid-June. They’ll phase out in 2014 when private insurance companies will be forced to sell policies to the “medically uninsurable.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/insurance/health-law-expands-high-risk-coverage-npr/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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In California, it’s been seven months since some 3 million poor and disabled adults lost their dental coverage to budget cuts.
And in thousands of dentist’s offices and community clinics – from the rocky north coast to the Mexican border – it’s the receptionists who are left to counsel and console patients who have lost their benefits.
“They will come here, crying they need help,” says Claudia Rico, a receptionist at Clinica de Salud del Valle de Salinas, a safety-net dental clinic in the central coast town of Salinas.
While the recession may be easing, California and other states across the country continue to face eye-popping budget deficits. As a result, states are cutting deep into public health programs, and dental benefits for Medicaid recipients top the list.
Rico says more patients are showing up each day with swollen gums and infected teeth. Before the state budget cuts, Medicaid patients here could get annual exams, cleanings and, if needed, root canals to save their teeth.
Now, Rico says, patients can’t afford to pay for root canals themselves – even at the discounted rate of $600. So they end up getting their teeth pulled.
“They’d rather take it out because they don’t have the money,” Rico says. “It’s either rent, food or dental work, and they opt for the most convenient – well, inconvenient for them – but the only thing they can do to relieve the pain.”
Waiting Until The Pain Is Unbearable
In interviews with dozens of dentists and safety-net clinics around California, providers say patients are forgoing routine cleanings and delaying care until the pain is unbearable. Dentists are offering discounts and payment plans, but they say few patients can afford them. Dental schools and free clinics are overrun, and some private dental offices and at least one community dental clinic have closed.
Under federal law, dental coverage is considered an optional benefit that states don’t have to provide when insuring poor or disabled residents. In fact, at least seven states – Virginia, Delaware, Alabama, Texas, Colorado, Utah and Missouri – provide absolutely no coverage, even for emergency relief of pain and infection. And a growing number of states have scaled back their programs and cover dental emergencies only.
“In the last recession and this recession and when states are under severe budget strains, dental benefits for adults, since they are an optional benefit, are among the first things to go,” says Julia Paradise, a Kaiser Family Foundation health researcher.
In California, the state will still pay to have a tooth pulled in an emergency, but it no longer covers the cost of expensive dentures. That’s a big problem for seniors. Medicare doesn’t cover dental, so poor seniors in California have long relied on state dental benefits when they need dentures.
‘An Orphaned Organ’
Lucresha Renteria runs the Mendocino Coast Clinics in Fort Bragg, a fishing-and-lumber town.
“The nutritional needs of the patient can’t be met if they can’t chew and eat food appropriately,” Renteria says. “So we have patients that suffer from a form of anorexia or have to have soft food only.”
The mouth has long been an orphaned organ, says Dr. Burton Edelstein, a Columbia University professor of dentistry and health policy. When Medicaid and Medicare were created in 1965, Edelstein says, oral health was not well understood, and Congress didn’t think to mandate dental coverage.
“It reflected policymakers’ misunderstanding that the mouth is not part of the body and that oral health is not an important component of general health,” Edelstein says.
That has largely changed. Over the last decade, federal public health agencies have aggressively promoted oral health, stressing its connection to diabetes, stroke and heart disease. Oral health advocates say the cancellation of dental coverage for poor and disabled adults in California – and elsewhere around the country – comes just as they were gaining ground on dental disease.
Not Likely To Change
But Michael Bird, from the National Conference of State Legislatures, says it will be a long time before states restore optional benefits, like dental coverage.
“The fiscal downturn is so severe that, even if you were to raise taxes or fees, you still aren’t going to be able to plug all of the holes that exist right now,” Bird says. “This is all about saving part of the school year versus the early release of prisoners versus an optional dental program versus whether you’re going to be able to fill the potholes on the roads.”
Bird says state coffers are empty and all the easy choices were made long ago.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/medicaid/npr-dental-coverage-in-california/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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The rules for how health insurers use age to set premium rates vary widely from state to state. Some states require insurers to charge all residents – young and old – the same price.
But in many states, anything goes. Insurers can charge older people five, six or even 10 times more for health insurance than younger adults.
In trying to draft new national standards, the key congressional committees agree that older people should pay more. But they differ widely on just how much more.
The Pool-Party Analogy
So, imagine you’re at a pool party. It’s a mix of people in the neighborhood: some older folks, some middle-aged, new parents with screaming babies, new college grads. They’re all standing around in their bathing suits – itsy-bitsy and the not-so-itsy-bitsy.
For health insurance to work best, all of those people need to get in the pool.
Of course, the older folks jump in first. They’ve got more health problems and really need the insurance. Then, the middle-aged people and parents with young kids jump in. But the younger ones? The ones who are rocking the itsy-bitsy bikinis and board shorts? How do you get them to jump in, especially when the water looks really cold?
That is exactly the problem Congress is trying to figure out.
“There’s no magic involved in how you set premiums,” says Larry Levitt, vice president of the Kaiser Family Foundation. (KHN is a program of the foundation.)
He says the 20-somethings need to be in the pool because they help balance out the cost of insuring older people who use more medical care.
“You’re still going to have to raise enough money for premiums to pay for the health care services that people use,” he says.
The Debate Over Premiums
And just how do you raise premiums? Should younger people pay less while older people pay more? Or should we share the costs, since we’ll all be old some day?
The bill passed by the Senate Finance Committee would allow insurers to charge older adults four times the amount it charges younger people.
The House bill and the Senate health committee bill make a different choice: They would limit what insurers can charge older adults to two times the amount.
The insurance industry strongly prefers the higher 4-to-1 multiple.
Alissa Fox, senior vice president of the Blue Cross Blue Shield Association, says the fear is that if you make insurance too expensive for younger adults, they won’t buy it.
“It’s very important to have significant discounts for younger people so they purchase insurance,” Fox says.
What About The 55- to 64-Year-Olds?
But the insurance industry is leaving out a critical element, says Linda Blumberg, a researcher at the Urban Institute. She says the current health overhaul bills all provide subsidies for lower income Americans, and “the young adults tend to be lower income, so they really are buffered a great deal from the full impact.”
Blumberg is worried more about middle-income older Americans – those between 55 and 64 years old. Discounts for younger people mean “surcharges” for older ones – and those older adults are less likely to qualify for a government subsidy.
“More than half of individuals in that 55- to 64-year-old age group with incomes between 400 and 500 percent of the federal poverty level would have household health care financing burdens of 20 percent,” she says.
What Blumberg’s saying is that my mom – before she retired – would have ended up spending 20 percent of her income to buy health insurance. And because she earned too much to qualify for a government subsidy, she would be – as she says – “up a creek.”
Fox says to handle that problem, Congress should give special subsidies to older, middle-income people. But Congress is already apoplectic about the cost of overhauling the health care system, and according to several sources, has little appetite for giving subsidies to people who seem to make a pretty good living – around $54,000 a year.
Individualism Vs. Social Solidarity
There are other ways of getting young people in the pool. You can push them by making the penalties for going uninsured more expensive than a basic plan. The current bills do include penalties, but many economists and the insurance industry claim they’re not high enough to be effective.
You can also require employers to provide health insurance, since the majority of uninsured young people are working. The bills differ on how strongly they do this.
However Congress decides the issue, they could look to other countries that have both universal health care and a private insurance industry. None of them, including Germany and the Netherlands, use age or any other personal characteristic to set premiums.
In the end, this seemingly technical choice of where to set age rates may come down to America’s unique belief in individualism versus the principal of social solidarity.
Related KHN stories:
Health Insurance: How Much More Should Older People Pay?
People Who Choose Not To Have Health Insurance
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RENEE MONTAGNE, host:
As Congress works on bills that could provide health care coverage for all, one city has already done that. San Francisco began an ambitious program three years ago to provide care to every one of its uninsured residents. The city’s effort is a laboratory of sorts for the kinds of changes under debate in Congress.
From member station KQED, Sarah Varney reports.
Unidentified Man #1: Hello. Hi (unintelligible).
SARAH VARNEY: It’s a busy morning at North East Medical Services, a large community clinic in San Francisco’s Chinatown. Tse Dong Chow(ph) is here for a check-up. He’s a trim and energetic 60-year-old wearing a pressed brown corduroy jacket, a Polo shirt, and jeans.
Mr. TSE DONG CHOW: (Foreign language spoken)
VARNEY: Chow works part-time as a Chinese language instructor, but could never afford a private health plan. So earlier this year he signed up for San Francisco’s public health plan, Healthy San Francisco. Based on his income, he pays a premium of $50 a month and in return receives comprehensive medical care.
Mr. CHOW: (Foreign language spoken)
VARNEY: Speaking through a translator, Chow says he hadn’t seen a doctor in four years.
Unidentified Woman (Translator): In the past when he’s sick, he would read medical books. Then he asked his relatives from China to help buy some medication and send it over for him.
VARNEY: With his Healthy San Francisco membership, Chow now sees a primary care doctor. He’s been diagnosed with severe hypertension and for the first time is on medication to control it. His physician, Dr. Ted Li, says Tse Dong Chow is typical of the patients he treats under San Francisco’s health plan.
Dr. TED LI (North East Medical Services, San Francisco): We see a lot of patients who have delayed their medical care and who have had chronic problems for a number of years, but have developed complications from these chronic medical problems and finally come in to see us.
VARNEY: Healthy San Francisco is not insurance. Enrollees aren’t covered for medical care outside of the city’s boundaries. Instead, they have access to a network of public and private clinics and hospitals within San Francisco. The program costs the city $280 per enrollee per month, significantly more than $50 premium Chow is paying. The city makes up the difference with public dollars, patient co-pays, and mandatory employer contributions from large and medium-sized businesses. Tangerine Brigham oversees the health plan.
Ms. TANGERINE BRIGHAM (Community Health Program Officer, Healthy San Francisco): Prior to Healthy San Francisco, if someone was uninsured, they had a very difficult time accessing care. It was somewhat of a fragmented system, they didn’t know when to receive services. Healthy San Francisco creates a more coordinated system of care for uninsured.
VARNEY: The program allows each patient to select a home clinic that coordinates care and manages any chronic conditions. Medical records are now in one centralized computer system. Patients are expected to seek non-emergency care at their home clinic.
The program is now in its third year and some of the early data show the focus on coordinated and preventative care is working. Hospital admissions among plan members have dropped sharply, and the average number of days in the hospital has been cut almost in half, suggesting chronic illnesses like diabetes, asthma, and hypertension are better controlled.
Researchers are also beginning to evaluate the economic effects of Healthy San Francisco. Some businesses feared the mandatory employer contributions that help fund about 10 percent of the program would lead to widespread layoffs.
Mr. WILLIAM DOW (Health Economist, U.C. Berkeley): There’s no evidence at all that Healthy San Francisco’s payer-plan employer mandate is adversely affecting employment.
VARNEY: Professor Will Dow, a health economist at U.C. Berkeley and a Bush administration advisor, found that businesses in San Francisco did not lay off workers in response to the city’s health care mandate. But Kevin Wesley from the Golden Gate Restaurant Association says businesses are hurting. He says some restaurants have stopped serving lunch or cut down on the number of nights they serve dinner. That may not lead to higher unemployment, says Wesley, but it does affect employees’ incomes.
Mr. KEVIN WESLEY (Golden Gate Restaurant Association): Restaurants have an increased expense and they’ve reacted the only way they can in a recession and that is to try to pass the cost along to the customer and reduce their overhead as best they can in order to survive.
VARNEY: Wesley’s group has sued to block San Francisco’s health spending requirement and the case is on appeal to the U.S. Supreme Court. All the major health care proposals in Congress include employer mandates from medium and large firms. And there’s been prolonged debate over how much those businesses should kick in. For that reason, Healthy San Francisco’s impact on employers is instructive, says Gail Wilensky. She oversaw the federal Medicare and Medicaid programs for the first President Bush. But Wilensky says the lessons learned from San Francisco’s experiment are limited.
Ms. GAIL WILENSKY: The question of how employers will respond when they face an increase in labor costs depends on how competitive the industry is and whether or not there are alternative ways to provide the service. So it’s why, for example, you see an increase in the number of self-checkout counters in supermarkets.
VARNEY: Restaurants and retail stores can’t easily cut back on their labor costs, says Wilensky, so they’re left with raising prices, and that’s what many restaurants in San Francisco have done, by including a 4 percent health care surcharge on menus. So far it’s a surcharge San Franciscans seem willing to pay.
For NPR News, I’m Sarah Varney.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/news/npr-san-francisco/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
<img id="republication-tracker-tool-source" src="/?republication-pixel=true&post=21419&ga4=G-J74WWTKFM0" style="width:1px;height:1px;">]]>One such ad from Americans for Prosperity features a woman talking of her experience with getting treatment for cancer.
“I survived a brain tumor, but if I’d relied on my government for health care, I’d be dead. I am a Canadian citizen. As my brain tumor got worse, my government health care system told me I had to wait six month to see a specialist,” the woman says.
The ads are provocative, but just how accurately do they portray Canada’s system?
At a small doctor’s office in the gritty working-class neighborhood of East Vancouver, Dr. Larry Barzelai meets with John and Bessie Riley, who have been his patients for more than 20 years.
John Riley was recently diagnosed with colon cancer. Contrary to the woman in the TV ad, he says his experience getting in to see specialists has been “nothing but good” so far. “Everything’s gone bang, bang. I’ve had no waiting times for anything,” he says, adding that his only out-of-pocket expense has been the cost of getting to the doctor’s office.
Socialized Insurance, Not Socialized Medicine
Canada has a universal health care system that’s paid for through income taxes and sales tax. All Canadians are covered, and they can see any doctor they want anywhere in the country with no copays or deductibles. Some things aren’t covered: optometry, dentistry and outpatient prescription drugs. Many Canadians have private insurance to cover those services, though some struggle to pay for them out of pocket.
U.S. critics of Canadian health care like to call it socialized medicine, but it’s more like socialized insurance – meaning the risk is pooled together. And while the individual provinces and territories set their overall health budgets and administer the health plans, the delivery of medical care is private. Doctors run their own businesses and then bill the government.
Barzelai says physicians in Canada earn a good living and aren’t faced with the same administrative hassles that American doctors gripe about. “Medical costs here are half of what medical costs in the States are,” he says. “At the same time, our infant mortality is lower, our life expectancy is longer, our rates of obesity are a lot less. So there’s got to be some positive aspects of living in Canada and with the Canadian medical system.”
The Commonwealth Fund, a respected and nonpartisan U.S. health research organization, looked at deaths that could have been prevented with access to quality medical care in the leading 19 industrialized countries. In the latest survey, the United States ranked last and Canada came in sixth.
Professor Bob Evans, one of the grandfathers of the health economics field, has been studying the Canadian and U.S. systems since they were founded around the same time in the mid-1960s. He says that what many Americans hear about Canada – rationed care, long wait lists and a government bureaucrat who gets in between a patient and doctor – is “absolute nonsense.”
“Are there cases of people who wind up not getting the care they need at appropriate times? Yes, of course there are,” says Evans, who is with the Centre for Health Policy Research at the University of British Columbia in Vancouver. “This is a huge system and it’s a very complicated one and things do go wrong. But as a general rule, what happens here is that when you need the care, you get it.” But that wasn’t always the case.
‘The Most Frustrating Moments In Our System’
When federal spending on Canadian health care declined during a recession in the 1990s, lines for non-urgent procedures – and some urgent ones – grew. A few years later, Canada’s Supreme Court found that some patients had in fact died as a result of waiting for medical services. Stories of the deaths and of residents traveling to the U.S. for medical care dominated Canadian news coverage.
In response, Canada’s government poured billions of dollars into reducing wait times in the five medical areas deemed most troublesome, including cancer care, cardiac care and joint replacement surgery. And wait times for these services has dropped: Most provinces now report those times on publicly available Web sites. Such data – and public accountability – don’t exist in the U.S.
But that’s not to say there still aren’t frustrations with waiting for medical care in Canada.
Jocelyn Thompkinson is a peppy 29-year-old who was born with a neural tube defect similar to spina bifida. “I haven’t been able to walk since I was 8, and I’ve had lots of surgeries, lots of medical interventions of various types,” she says at BC Children’s Hospital, in a leafy Vancouver neighborhood. “But beyond that, I hold a job, I have a pretty much normal life.”
She credits an army of Canadian doctors and physical therapists for giving her that normal life, though there have been roadblocks. “Of course there were some times when I had to wait for care, and those are always the most frustrating moments in our system,” Thompkinson says. Several years ago, when she was on a long waiting list for a pain clinic in Vancouver, she traveled to Seattle and then Texas to get care. The visits and tests cost her $1,800.
Few Canadians actually go south for medical care, though. Canadian researchers say it’s a bit like getting struck by lighting – it’s extremely rare, but when it happens, everyone talks about it.
Provincial governments do pay for Canadians to receive specialty care in the U.S. in some cases. For example, a shortage of neonatal beds means a small number of women with high-risk pregnancies are sent to U.S. hospitals to deliver their babies.
It doesn’t happen often, though, and public opinion polls continue to show strong support for publicly financed, universal health care in Canada.
An Option To Buy
Keith Neuman of Environics, a long-standing Canadian polling group, says, “It’s not something that everybody is completely satisfied with or complacent about. There are concerns about waiting and that sort of thing. But when you ask people about their experience and the experience of people they know, the vast majority think the system’s pretty good.”
At the same time, he says, about half of Canadians say they would like the option to buy a private health insurance plan. Currently, that’s not allowed.
In many ways, Canada is confronting some of the same problems as the U.S. – anxiety over how to pay for its aging baby boomers, a shortage of primary care doctors, and too many people who overuse hospital emergency departments. But what Canadians don’t worry about is losing their health insurance or going bankrupt because of an injury or illness.
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Voters don’t give much thought to who runs their state department of insurance. But as key provisions of the new federal health law begin to take effect, the insurance commissioner will become the king of a much bigger kingdom.
Voters in four states, including Georgia and California, will directly elect an insurance chief on Tuesday. And in nearly three dozen other states, whoever is elected governor will name the commissioner.
Fame does not come easy to even the most heroic insurance commissioner. California’s current chief forced health plans to scale back double-digit rate hikes, and still he’s the white knight no one can name.
Steve Poizner is the California insurance commissioner, and whoever replaces him – and other insurance chiefs around the nation – could change your life.
“With the insurance market reforms, it’s really going to be important for states to take a proactive role in responding to any problems that come up and making sure plans are complying with the law,” says Sabrina Corlette, a health policy researcher at Georgetown University.
New Consumer Protections
She says that under the federal health law, state insurance chiefs will have a long list of new consumer protections to enforce. For example, starting in 2014, health plans can’t charge women or sicker people more.
They’re also helping to write the regulations for their own expanded powers. Congress left it up to an obscure group – the National Association of Insurance Commissioners – to essentially decide critical details, such as what health plans can claim as actual medical care vs. administration and profit.
Corlette says this decision made these humble regulators very popular with industry lobbyists at their spring meeting.
“I was stunned to discover that there were about 17 consumer representatives that were focused on health care, compared to over 1,000 different insurance industry representatives,” she says.
Consumer advocates and industry officials say once the rules are written, state regulators will have to crack down on health plans looking to exploit fuzzy rules or weak enforcement. At the same time, if they’re too heavy-handed, the plans might leave the market.
State Impact On Federal Health Overhaul
All of which means state insurance chiefs could very well play a key role in whether the federal health overhaul flies or flops. Laurie Sobel, a senior attorney with the consumer advocacy group Consumers Union, says it matters how the insurance commissioners view the new federal health law.
“If you have one that really doesn’t want to enforce it, then consumers are going to need to fight it every step of the way,” Sobel says.
The two candidates vying to become California’s chief regulator have starkly different views on how best to protect consumers. Assemblyman Mike Villines, the Republican in the race, is a skeptic about whether the government can fix a system he admits is broken.
“When you start to get into mandating behavior and you have to tell the insurance companies there are these for-sure things in here that you have to do – I think that Californians and the nation is not quite ready for that,” Villines says.
His opponent, Democratic Assemblyman Dave Jones, says the federal overhaul will offer critical protections and new choices to consumers.
“I plan to use the office both formally and informally, to take a very assertive role in terms of health insurance reform,” Jones says.
Bad News For Reformers?
Overseeing the national rule-writing effort is Kansas Insurance Commissioner Sandy Praeger. She’s up for re-election – a Republican in a solidly red state and running unopposed. With no challenger, she’s instead spending her time worrying about all the details her group must decide.
“I don’t want to get thrown under the bus,” Praeger says. “We don’t want to be blamed if this isn’t working. So we’ve got a huge responsibility to try to get it right.
But many Republican candidates for governor think the law is just wrong. And in some states, those candidates – who could end up appointing new insurance chiefs – want to repeal the federal health overhaul.
With Democrats on the ropes nationwide, that could be bad news for reformers.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/insurance/npr-insurance-commissioners/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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When Miles Owyang was born, six weeks premature, the doctors determined that he had a heart ailment. It was nothing serious, just something to monitor.
Today, Miles is a radiant 9-year-old and a fierce tennis and lacrosse player. Health insurance for him was never a problem until his parents, both Silicon Valley electrical engineers, lost their jobs and their employer-based insurance, and had to look for an individual family policy.
No insurer would accept Miles.
His mom, Tara Anderson, applied to join California’s high-risk pool. “They told us it will probably be about three months before he’s accepted,” she says.
The high-risk pools in most states are largely viewed as a failure. They were originally meant as insurers of last resort for those shut out of the private health insurance market, but according to the national association of state high-risk programs, the pools cover only about 200,000 Americans.
The California plan is capped at 7,100 members and often has a waiting list. Premiums and deductibles are wildly expensive, and the policies have spending caps that are frequently exceeded.
The new federal health care law sets aside $5 billion to fund new high-risk programs that are more affordable and open to more people.
Deborah Chollet, a health insurance expert at the nonpartisan research firm Mathematica, says people who apply to the new programs will pay a standard rate, or the rate they would pay for a policy if they did not have a pre-existing condition that excluded them from coverage.
“That is an enormous benefit,” she says. Medical charges for people in a high-risk pool could drop by as much as a third, and they will no longer face annual or lifetime caps, Chollet adds. A family would pay no more than $11,900 a year. Individuals would pay under $6,000 a year.
Enrollment rules will loosen as well. In some states, current applicants must prove that private insurers rejected them. Under the new law, anyone with a pre-existing condition who lacks coverage can join the program. The federal government will define what those conditions are, but they are likely to be the same long list used by insurers, including cancer, diabetes, heart disease and even pregnancy.
“My sense is they’re going to let people in under all reasonable circumstances … if someone has made every effort to maintain coverage, they would be eligible for this,” Chollet says. She adds that 1 million to 2 million people could gain coverage under the federally financed program.
Some of the $5 billion federal allocation will likely go straight to states to expand their pools. However, about 15 states don’t have high-risk pools, and others would have to change their laws to qualify for the funds. The federal government will likely also offer a national pool.
Still, Lesley Cummings, director of the California Major Risk Medical Insurance Program, the state’s high-risk pool, says she has far more questions than answers about the new program. “We don’t yet know the details of how it will work, and are eager to talk about this with our federal colleagues,” Cummings says.
The federal government has begun reaching out to states, to gauge their interest in starting or expanding coverage for the medically uninsurable. States have until the end of this month to submit an application.
The law says these new high-risk pools must be implemented by mid-June. They’ll phase out in 2014 when private insurance companies will be forced to sell policies to the “medically uninsurable.”
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/insurance/health-law-expands-high-risk-coverage-npr/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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In California, it’s been seven months since some 3 million poor and disabled adults lost their dental coverage to budget cuts.
And in thousands of dentist’s offices and community clinics – from the rocky north coast to the Mexican border – it’s the receptionists who are left to counsel and console patients who have lost their benefits.
“They will come here, crying they need help,” says Claudia Rico, a receptionist at Clinica de Salud del Valle de Salinas, a safety-net dental clinic in the central coast town of Salinas.
While the recession may be easing, California and other states across the country continue to face eye-popping budget deficits. As a result, states are cutting deep into public health programs, and dental benefits for Medicaid recipients top the list.
Rico says more patients are showing up each day with swollen gums and infected teeth. Before the state budget cuts, Medicaid patients here could get annual exams, cleanings and, if needed, root canals to save their teeth.
Now, Rico says, patients can’t afford to pay for root canals themselves – even at the discounted rate of $600. So they end up getting their teeth pulled.
“They’d rather take it out because they don’t have the money,” Rico says. “It’s either rent, food or dental work, and they opt for the most convenient – well, inconvenient for them – but the only thing they can do to relieve the pain.”
Waiting Until The Pain Is Unbearable
In interviews with dozens of dentists and safety-net clinics around California, providers say patients are forgoing routine cleanings and delaying care until the pain is unbearable. Dentists are offering discounts and payment plans, but they say few patients can afford them. Dental schools and free clinics are overrun, and some private dental offices and at least one community dental clinic have closed.
Under federal law, dental coverage is considered an optional benefit that states don’t have to provide when insuring poor or disabled residents. In fact, at least seven states – Virginia, Delaware, Alabama, Texas, Colorado, Utah and Missouri – provide absolutely no coverage, even for emergency relief of pain and infection. And a growing number of states have scaled back their programs and cover dental emergencies only.
“In the last recession and this recession and when states are under severe budget strains, dental benefits for adults, since they are an optional benefit, are among the first things to go,” says Julia Paradise, a Kaiser Family Foundation health researcher.
In California, the state will still pay to have a tooth pulled in an emergency, but it no longer covers the cost of expensive dentures. That’s a big problem for seniors. Medicare doesn’t cover dental, so poor seniors in California have long relied on state dental benefits when they need dentures.
‘An Orphaned Organ’
Lucresha Renteria runs the Mendocino Coast Clinics in Fort Bragg, a fishing-and-lumber town.
“The nutritional needs of the patient can’t be met if they can’t chew and eat food appropriately,” Renteria says. “So we have patients that suffer from a form of anorexia or have to have soft food only.”
The mouth has long been an orphaned organ, says Dr. Burton Edelstein, a Columbia University professor of dentistry and health policy. When Medicaid and Medicare were created in 1965, Edelstein says, oral health was not well understood, and Congress didn’t think to mandate dental coverage.
“It reflected policymakers’ misunderstanding that the mouth is not part of the body and that oral health is not an important component of general health,” Edelstein says.
That has largely changed. Over the last decade, federal public health agencies have aggressively promoted oral health, stressing its connection to diabetes, stroke and heart disease. Oral health advocates say the cancellation of dental coverage for poor and disabled adults in California – and elsewhere around the country – comes just as they were gaining ground on dental disease.
Not Likely To Change
But Michael Bird, from the National Conference of State Legislatures, says it will be a long time before states restore optional benefits, like dental coverage.
“The fiscal downturn is so severe that, even if you were to raise taxes or fees, you still aren’t going to be able to plug all of the holes that exist right now,” Bird says. “This is all about saving part of the school year versus the early release of prisoners versus an optional dental program versus whether you’re going to be able to fill the potholes on the roads.”
Bird says state coffers are empty and all the easy choices were made long ago.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/medicaid/npr-dental-coverage-in-california/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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The rules for how health insurers use age to set premium rates vary widely from state to state. Some states require insurers to charge all residents – young and old – the same price.
But in many states, anything goes. Insurers can charge older people five, six or even 10 times more for health insurance than younger adults.
In trying to draft new national standards, the key congressional committees agree that older people should pay more. But they differ widely on just how much more.
The Pool-Party Analogy
So, imagine you’re at a pool party. It’s a mix of people in the neighborhood: some older folks, some middle-aged, new parents with screaming babies, new college grads. They’re all standing around in their bathing suits – itsy-bitsy and the not-so-itsy-bitsy.
For health insurance to work best, all of those people need to get in the pool.
Of course, the older folks jump in first. They’ve got more health problems and really need the insurance. Then, the middle-aged people and parents with young kids jump in. But the younger ones? The ones who are rocking the itsy-bitsy bikinis and board shorts? How do you get them to jump in, especially when the water looks really cold?
That is exactly the problem Congress is trying to figure out.
“There’s no magic involved in how you set premiums,” says Larry Levitt, vice president of the Kaiser Family Foundation. (KHN is a program of the foundation.)
He says the 20-somethings need to be in the pool because they help balance out the cost of insuring older people who use more medical care.
“You’re still going to have to raise enough money for premiums to pay for the health care services that people use,” he says.
The Debate Over Premiums
And just how do you raise premiums? Should younger people pay less while older people pay more? Or should we share the costs, since we’ll all be old some day?
The bill passed by the Senate Finance Committee would allow insurers to charge older adults four times the amount it charges younger people.
The House bill and the Senate health committee bill make a different choice: They would limit what insurers can charge older adults to two times the amount.
The insurance industry strongly prefers the higher 4-to-1 multiple.
Alissa Fox, senior vice president of the Blue Cross Blue Shield Association, says the fear is that if you make insurance too expensive for younger adults, they won’t buy it.
“It’s very important to have significant discounts for younger people so they purchase insurance,” Fox says.
What About The 55- to 64-Year-Olds?
But the insurance industry is leaving out a critical element, says Linda Blumberg, a researcher at the Urban Institute. She says the current health overhaul bills all provide subsidies for lower income Americans, and “the young adults tend to be lower income, so they really are buffered a great deal from the full impact.”
Blumberg is worried more about middle-income older Americans – those between 55 and 64 years old. Discounts for younger people mean “surcharges” for older ones – and those older adults are less likely to qualify for a government subsidy.
“More than half of individuals in that 55- to 64-year-old age group with incomes between 400 and 500 percent of the federal poverty level would have household health care financing burdens of 20 percent,” she says.
What Blumberg’s saying is that my mom – before she retired – would have ended up spending 20 percent of her income to buy health insurance. And because she earned too much to qualify for a government subsidy, she would be – as she says – “up a creek.”
Fox says to handle that problem, Congress should give special subsidies to older, middle-income people. But Congress is already apoplectic about the cost of overhauling the health care system, and according to several sources, has little appetite for giving subsidies to people who seem to make a pretty good living – around $54,000 a year.
Individualism Vs. Social Solidarity
There are other ways of getting young people in the pool. You can push them by making the penalties for going uninsured more expensive than a basic plan. The current bills do include penalties, but many economists and the insurance industry claim they’re not high enough to be effective.
You can also require employers to provide health insurance, since the majority of uninsured young people are working. The bills differ on how strongly they do this.
However Congress decides the issue, they could look to other countries that have both universal health care and a private insurance industry. None of them, including Germany and the Netherlands, use age or any other personal characteristic to set premiums.
In the end, this seemingly technical choice of where to set age rates may come down to America’s unique belief in individualism versus the principal of social solidarity.
Related KHN stories:
Health Insurance: How Much More Should Older People Pay?
People Who Choose Not To Have Health Insurance
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RENEE MONTAGNE, host:
As Congress works on bills that could provide health care coverage for all, one city has already done that. San Francisco began an ambitious program three years ago to provide care to every one of its uninsured residents. The city’s effort is a laboratory of sorts for the kinds of changes under debate in Congress.
From member station KQED, Sarah Varney reports.
Unidentified Man #1: Hello. Hi (unintelligible).
SARAH VARNEY: It’s a busy morning at North East Medical Services, a large community clinic in San Francisco’s Chinatown. Tse Dong Chow(ph) is here for a check-up. He’s a trim and energetic 60-year-old wearing a pressed brown corduroy jacket, a Polo shirt, and jeans.
Mr. TSE DONG CHOW: (Foreign language spoken)
VARNEY: Chow works part-time as a Chinese language instructor, but could never afford a private health plan. So earlier this year he signed up for San Francisco’s public health plan, Healthy San Francisco. Based on his income, he pays a premium of $50 a month and in return receives comprehensive medical care.
Mr. CHOW: (Foreign language spoken)
VARNEY: Speaking through a translator, Chow says he hadn’t seen a doctor in four years.
Unidentified Woman (Translator): In the past when he’s sick, he would read medical books. Then he asked his relatives from China to help buy some medication and send it over for him.
VARNEY: With his Healthy San Francisco membership, Chow now sees a primary care doctor. He’s been diagnosed with severe hypertension and for the first time is on medication to control it. His physician, Dr. Ted Li, says Tse Dong Chow is typical of the patients he treats under San Francisco’s health plan.
Dr. TED LI (North East Medical Services, San Francisco): We see a lot of patients who have delayed their medical care and who have had chronic problems for a number of years, but have developed complications from these chronic medical problems and finally come in to see us.
VARNEY: Healthy San Francisco is not insurance. Enrollees aren’t covered for medical care outside of the city’s boundaries. Instead, they have access to a network of public and private clinics and hospitals within San Francisco. The program costs the city $280 per enrollee per month, significantly more than $50 premium Chow is paying. The city makes up the difference with public dollars, patient co-pays, and mandatory employer contributions from large and medium-sized businesses. Tangerine Brigham oversees the health plan.
Ms. TANGERINE BRIGHAM (Community Health Program Officer, Healthy San Francisco): Prior to Healthy San Francisco, if someone was uninsured, they had a very difficult time accessing care. It was somewhat of a fragmented system, they didn’t know when to receive services. Healthy San Francisco creates a more coordinated system of care for uninsured.
VARNEY: The program allows each patient to select a home clinic that coordinates care and manages any chronic conditions. Medical records are now in one centralized computer system. Patients are expected to seek non-emergency care at their home clinic.
The program is now in its third year and some of the early data show the focus on coordinated and preventative care is working. Hospital admissions among plan members have dropped sharply, and the average number of days in the hospital has been cut almost in half, suggesting chronic illnesses like diabetes, asthma, and hypertension are better controlled.
Researchers are also beginning to evaluate the economic effects of Healthy San Francisco. Some businesses feared the mandatory employer contributions that help fund about 10 percent of the program would lead to widespread layoffs.
Mr. WILLIAM DOW (Health Economist, U.C. Berkeley): There’s no evidence at all that Healthy San Francisco’s payer-plan employer mandate is adversely affecting employment.
VARNEY: Professor Will Dow, a health economist at U.C. Berkeley and a Bush administration advisor, found that businesses in San Francisco did not lay off workers in response to the city’s health care mandate. But Kevin Wesley from the Golden Gate Restaurant Association says businesses are hurting. He says some restaurants have stopped serving lunch or cut down on the number of nights they serve dinner. That may not lead to higher unemployment, says Wesley, but it does affect employees’ incomes.
Mr. KEVIN WESLEY (Golden Gate Restaurant Association): Restaurants have an increased expense and they’ve reacted the only way they can in a recession and that is to try to pass the cost along to the customer and reduce their overhead as best they can in order to survive.
VARNEY: Wesley’s group has sued to block San Francisco’s health spending requirement and the case is on appeal to the U.S. Supreme Court. All the major health care proposals in Congress include employer mandates from medium and large firms. And there’s been prolonged debate over how much those businesses should kick in. For that reason, Healthy San Francisco’s impact on employers is instructive, says Gail Wilensky. She oversaw the federal Medicare and Medicaid programs for the first President Bush. But Wilensky says the lessons learned from San Francisco’s experiment are limited.
Ms. GAIL WILENSKY: The question of how employers will respond when they face an increase in labor costs depends on how competitive the industry is and whether or not there are alternative ways to provide the service. So it’s why, for example, you see an increase in the number of self-checkout counters in supermarkets.
VARNEY: Restaurants and retail stores can’t easily cut back on their labor costs, says Wilensky, so they’re left with raising prices, and that’s what many restaurants in San Francisco have done, by including a 4 percent health care surcharge on menus. So far it’s a surcharge San Franciscans seem willing to pay.
For NPR News, I’m Sarah Varney.
麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .This <a target="_blank" href="/news/npr-san-francisco/">article</a> first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
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“I survived a brain tumor, but if I’d relied on my government for health care, I’d be dead. I am a Canadian citizen. As my brain tumor got worse, my government health care system told me I had to wait six month to see a specialist,” the woman says.
The ads are provocative, but just how accurately do they portray Canada’s system?
At a small doctor’s office in the gritty working-class neighborhood of East Vancouver, Dr. Larry Barzelai meets with John and Bessie Riley, who have been his patients for more than 20 years.
John Riley was recently diagnosed with colon cancer. Contrary to the woman in the TV ad, he says his experience getting in to see specialists has been “nothing but good” so far. “Everything’s gone bang, bang. I’ve had no waiting times for anything,” he says, adding that his only out-of-pocket expense has been the cost of getting to the doctor’s office.
Socialized Insurance, Not Socialized Medicine
Canada has a universal health care system that’s paid for through income taxes and sales tax. All Canadians are covered, and they can see any doctor they want anywhere in the country with no copays or deductibles. Some things aren’t covered: optometry, dentistry and outpatient prescription drugs. Many Canadians have private insurance to cover those services, though some struggle to pay for them out of pocket.
U.S. critics of Canadian health care like to call it socialized medicine, but it’s more like socialized insurance – meaning the risk is pooled together. And while the individual provinces and territories set their overall health budgets and administer the health plans, the delivery of medical care is private. Doctors run their own businesses and then bill the government.
Barzelai says physicians in Canada earn a good living and aren’t faced with the same administrative hassles that American doctors gripe about. “Medical costs here are half of what medical costs in the States are,” he says. “At the same time, our infant mortality is lower, our life expectancy is longer, our rates of obesity are a lot less. So there’s got to be some positive aspects of living in Canada and with the Canadian medical system.”
The Commonwealth Fund, a respected and nonpartisan U.S. health research organization, looked at deaths that could have been prevented with access to quality medical care in the leading 19 industrialized countries. In the latest survey, the United States ranked last and Canada came in sixth.
Professor Bob Evans, one of the grandfathers of the health economics field, has been studying the Canadian and U.S. systems since they were founded around the same time in the mid-1960s. He says that what many Americans hear about Canada – rationed care, long wait lists and a government bureaucrat who gets in between a patient and doctor – is “absolute nonsense.”
“Are there cases of people who wind up not getting the care they need at appropriate times? Yes, of course there are,” says Evans, who is with the Centre for Health Policy Research at the University of British Columbia in Vancouver. “This is a huge system and it’s a very complicated one and things do go wrong. But as a general rule, what happens here is that when you need the care, you get it.” But that wasn’t always the case.
‘The Most Frustrating Moments In Our System’
When federal spending on Canadian health care declined during a recession in the 1990s, lines for non-urgent procedures – and some urgent ones – grew. A few years later, Canada’s Supreme Court found that some patients had in fact died as a result of waiting for medical services. Stories of the deaths and of residents traveling to the U.S. for medical care dominated Canadian news coverage.
In response, Canada’s government poured billions of dollars into reducing wait times in the five medical areas deemed most troublesome, including cancer care, cardiac care and joint replacement surgery. And wait times for these services has dropped: Most provinces now report those times on publicly available Web sites. Such data – and public accountability – don’t exist in the U.S.
But that’s not to say there still aren’t frustrations with waiting for medical care in Canada.
Jocelyn Thompkinson is a peppy 29-year-old who was born with a neural tube defect similar to spina bifida. “I haven’t been able to walk since I was 8, and I’ve had lots of surgeries, lots of medical interventions of various types,” she says at BC Children’s Hospital, in a leafy Vancouver neighborhood. “But beyond that, I hold a job, I have a pretty much normal life.”
She credits an army of Canadian doctors and physical therapists for giving her that normal life, though there have been roadblocks. “Of course there were some times when I had to wait for care, and those are always the most frustrating moments in our system,” Thompkinson says. Several years ago, when she was on a long waiting list for a pain clinic in Vancouver, she traveled to Seattle and then Texas to get care. The visits and tests cost her $1,800.
Few Canadians actually go south for medical care, though. Canadian researchers say it’s a bit like getting struck by lighting – it’s extremely rare, but when it happens, everyone talks about it.
Provincial governments do pay for Canadians to receive specialty care in the U.S. in some cases. For example, a shortage of neonatal beds means a small number of women with high-risk pregnancies are sent to U.S. hospitals to deliver their babies.
It doesn’t happen often, though, and public opinion polls continue to show strong support for publicly financed, universal health care in Canada.
An Option To Buy
Keith Neuman of Environics, a long-standing Canadian polling group, says, “It’s not something that everybody is completely satisfied with or complacent about. There are concerns about waiting and that sort of thing. But when you ask people about their experience and the experience of people they know, the vast majority think the system’s pretty good.”
At the same time, he says, about half of Canadians say they would like the option to buy a private health insurance plan. Currently, that’s not allowed.
In many ways, Canada is confronting some of the same problems as the U.S. – anxiety over how to pay for its aging baby boomers, a shortage of primary care doctors, and too many people who overuse hospital emergency departments. But what Canadians don’t worry about is losing their health insurance or going bankrupt because of an injury or illness.
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