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      09-23-2013, 10:45 PM   #1
G-Bus
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Americans, get in here!

Hello fellow Americans,

Following a couple of posts that I read on reddit and on here, I still have some unanswered questions regarding your government and healthcare system that remain unanswered.

I was reading on reddit that, per capita, the US spends MORE money that Canada and most European countries for healthcare, yet, our view of your system is that it's horrible. With movies that were made about it and all the stories of people that paid for health insurance all their life and the insurance company decides not to pay for cancer treatment etc... it sounds honestly horrible.

Now looking at the stats, it's not THAT real. From what I gather, only 15% of the US population is UNINSURED, and for the 85% remaining all rate their healthcare services as good. From what I also seem to understand by reading is that even the uninsured have access to healthcare.

What's also funny is people saying that Canadians don't get taxed much more than Americans, which I don't believe is true because we have a lot of hidden taxes. Let me give you a few examples;

-Sales taxes equal out to roughly 15% (varies but mostly between 13 to 15% in most populated provinces)
-Drivers licence 80$/year if you haven't lost any points.
-Plates/Registration +/- 320$/year (more if the engine is over 4.0L in displacement)
-Sport Motorcycle plates/registration +$1000$/year
-Used cars are still taxed every time they are sold. So basically if the same car goes thru 10 owners, it's taxed 10 times.
-Eye care and dental care is NOT included in our healthcare. We pay for that, and honestly it's the most important because those are two things that EVERYBODY is going to need at one point in their life no matter what, whereas NOT everybody is going to need to go the emergency in their life.
-We have a green tax on most electronics, very tiny but it adds up, on top of paying top dollar for everything compared to Americans.
-Income tax rates Provincial (Quebec);
$41,095 or less 16%
More than $41,095 but not more than $82,190 20%
More than $82,190 But not more than $100,000 24%
More than $100,000 25.75%
-Income tax rate Federal;
15% on the first $43,561 of taxable income, +
22% on the next $43,562 of taxable income (on the portion of taxable income over $43,561 up to $87,123), +
26% on the next $47,931 of taxable income (on the portion of taxable income over $87,123 up to $135,054), +
29% of taxable income over $135,054.
You have to add both up, so for someone making, say 50k$ a year, which isn't all that much, you give 22% of it to the Federal Gov. and 20% to the Provincial Gov. which equals out to 44% OUT. That's almost HALF of your salary that you don't even get to see. When you make over 100k$ it's even close to 60%...

Now all the points are valid for most of Canada. I'm in Quebec so all of this is applicable here, not sure about the rest of Canada.

As for our healthcare system, it's NOT that great. Most of the population is between 50-80 years old, so you can imagine that the hospitals are ALWAYS full. We constantly have issues with the system, it hires MORE bureaucratics than nurses and doctors and we constantly have people dying in WAIT of treatment.

Another example of mine; a couple of years ago I was diagnosed with hernia. Not very urgent but none the less, can go very bad with one wrong move. I waited 14 months for surgery. I do not believe it is acceptable.


Now back to the US; how much "hidden" taxes do you guys pay? In terms of income taxes, you guys have a few states that have none such as Texas, Florida, Alaska, Washington, Nevada etc... These states house quite a few big cities. Also, most of States income taxes, from what I gather is below 5%, so in total, for somebody that makes 50k$/year, your income tax is less than 30%, opposed to 44% in Canada. Am I correct here or I'm miscalculating?

Now to get back to healthcare; how does one, who let's say makes 50k$, uninsured pay for those astronomical fees? Who covers them? I went quick and did some quotes as a 25 yr old male in good condition and it comes down to 600$/month. Now on top of paying that all my life, companies are that horrible to refuse to pay?! Say you didn't have a pre-existing condition, because obviously they'll not pay. On the other hand, I read around forums that the government covers it. Then where does this misconception of people not being taken care of in your hospitals comes from?!

I know most jobs pay for your healthcare. As a mater of fact, the company I work for provides to their US employees healthcare as well as a 401k. Roughly 5k$ less in terms of salary for the same position compared to Canada. They provide 80% dental but no eye care insurance in Canada.

Sorry for the long post, I really want to finally shed some light on this. I would LOVE to move to the USA but unfortunately it's almost impossible for a fellow Canadian to get there. I'm having a hard time getting a temporary working Visa due to my field. I have asked multiple times to transfer to the US since I work for an American company and was denied by the immigration department. I'm not special enough...

Anyhow, thanks to those who will take time to answer.

Last edited by G-Bus; 09-23-2013 at 10:52 PM.
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      09-23-2013, 11:36 PM   #2
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Very interesting stuff. Here's a little bit of information from California to compare.

-Sales taxes is about 9% here.
-Drivers licence is about $30 every 5 years
-Plates/Registration varies but I've paid anywhere from $150 - $350
-Sport Motorcycle plates/registration - Been a while since I owned one but it was dirt cheap. I don't remember the cost being significant. Similar to a car or less.
-Used cars are still taxed every time they are sold. So basically if the same car goes thru 10 owners, it's taxed 10 times. Same here. We are taxed based on it's sell price or value.
-Eye care and dental care depend on your health insurance. Most times it's not included in the basic health care. For example, if you have a employer who has benefits, you'll often have one play for medical and a seperate plan for eye and dental. For what it's worth, my last 2 or 3 employers have covered both.
-We have a green tax (electronic waste tax I believe) on some electronics. Stuff with screens like TVs and computer monitors for sure. Not sure what else it includes but I don't see it very often.

Regarding uninsured getting treatment - The emergency room will not turn anyone away. They are required to see you and treat any immediate issues. For example if you're having a heart attack, they will save your life and treat you. They will not, however, put you on a waiting list to get a heart transplant and sign you up for the surgery.

"how does one, who let's say makes 50k$, uninsured pay for those astronomical fees?" - I'd say most people making ~$50k are probably employed at a job that has coverage. I could be off base on that. Unless you're self employed, in which case you'd want to go out and get coverage separately (similar to automobile insurance). I went to the emergency room without coverage once and the bill for a 5 minute talk with the doctor was around $1,700. Thank god I drove myself because an ambulance ride could have doubled it.
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      09-24-2013, 11:25 AM   #3
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1) Health insurance isn't really health insurance. It should be there to cover disasters and not general health care. It'd be like expecting your car insurance to cover basic maintenance and repair rather than accidents. Consequently, people don't give a whit about how much their health care actually costs. There are no market forces to drive the costs down. Nobody is turned around in an ER, and we all cover those costs as well
2) We have the best health care in the world (at least until we regulate it out of existence and it moves to places like India). That's why for very advanced and risky procedures, even Canadians will come down here.
3) Government regulation, written by insurance industry lobbyists, forces us into an inefficient system designed to further limit competition and make health insurance portable.
4) Drugs aren't that expensive to produce; they're expensive to develop and test, especially with the onerous FDA here. We Americans cover this cost by paying full fare for the drugs. You Canadians can buy drugs at the marginal cost of production. Our government facilitates this by making it illegal for us to buy drugs out of country, limiting the free market. You're welcome.

Sales tax in most states is around 7%. I make about 100k and I once added up all my taxes (Income federal/state, property, sales) and figure I pay about 35% or so. Of course, the federal government taxes 18% of GDP (this includes our high corporates taxes) and spends 22% of GDP.

Last edited by carve; 09-24-2013 at 11:38 AM.
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      09-24-2013, 12:53 PM   #4
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Thanks for some of clarifications guys.
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      09-24-2013, 02:20 PM   #5
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The biggest hidden tax that we have is property taxes. Most people think that if they don't own property that they don't pay property taxes. But we all pay it no matter if renting or owning.

I own the house we live in and the building our business is in and a house that we rent out. Total property taxes this year. $17,360.00 My residence is what it is. The taxes for the rental home are figured as an expense for that house which is used to figure the rental price. The property taxes on the business building is figured into cost of overhead and added into the sale price of our goods and services. So everything except my residence is passed on to tenants or customers.
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      09-24-2013, 09:40 PM   #6
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Quote:
Originally Posted by Mr Tonka View Post
The biggest hidden tax that we have is property taxes. Most people think that if they don't own property that they don't pay property taxes. But we all pay it no matter if renting or owning.

I own the house we live in and the building our business is in and a house that we rent out. Total property taxes this year. $17,360.00 My residence is what it is. The taxes for the rental home are figured as an expense for that house which is used to figure the rental price. The property taxes on the business building is figured into cost of overhead and added into the sale price of our goods and services. So everything except my residence is passed on to tenants or customers.
We have property taxes too... They hijack the evaluations of the buildings to squeeze more money out of the owners. I should say that Toronto and Vancouver are way worse than Montreal is in terms of overpriced housing.
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      09-25-2013, 09:04 AM   #7
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Quote:
Originally Posted by carve
1) Health insurance isn't really health insurance. It should be there to cover disasters and not general health care. It'd be like expecting your car insurance to cover basic maintenance and repair rather than accidents. Consequently, people don't give a whit about how much their health care actually costs. There are no market forces to drive the costs down. Nobody is turned around in an ER, and we all cover those costs as well
2) We have the best health care in the world (at least until we regulate it out of existence and it moves to places like India). That's why for very advanced and risky procedures, even Canadians will come down here.
3) Government regulation, written by insurance industry lobbyists, forces us into an inefficient system designed to further limit competition and make health insurance portable.
4) Drugs aren't that expensive to produce; they're expensive to develop and test, especially with the onerous FDA here. We Americans cover this cost by paying full fare for the drugs. You Canadians can buy drugs at the marginal cost of production. Our government facilitates this by making it illegal for us to buy drugs out of country, limiting the free market. You're welcome.

Sales tax in most states is around 7%. I make about 100k and I once added up all my taxes (Income federal/state, property, sales) and figure I pay about 35% or so. Of course, the federal government taxes 18% of GDP (this includes our high corporates taxes) and spends 22% of GDP.
Great post. I would add, however, that there is a lot of competition in healthcare pricing, when insurance companies sign contracts with docs, hospitals, etc. if you don't have insurance, though, they will want to charge you list price.

Our legal system is very different from Canada, and contingency-based lawsuits are responsible for much of the cost of healthcare in the US.
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      09-25-2013, 05:43 PM   #8
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Quote:
Originally Posted by bbbbmw View Post
Great post. I would add, however, that there is a lot of competition in healthcare pricing, when insurance companies sign contracts with docs, hospitals, etc. if you don't have insurance, though, they will want to charge you list price.

Our legal system is very different from Canada, and contingency-based lawsuits are responsible for much of the cost of healthcare in the US.
They will want to charge you list.... But if you tell them you don't have the money and need to work something out they will immediately take about 60% off of the bill.

My wife's mother had a bike accident and was in a coma for several days. Was flown from the scene to the hospital, all the works. Their bill for all services totaled $117,000 for the 8 day stay and flight.

At the time, her parents were recently laid off and only 3 weeks from being medicare eligible, so had no insurance. We called the hospital and told them that her parents had no money to pay the bill and that we would be paying for it but didn't have much money either, so we'd have to work something out. The lady on the phone said "can you pay $33k?" Yes, yes maim we can.

We did that on the advise of a family friend who is a hospital administrator. he said that nearly every hospital in the nation will take about 30% - 40% of the total non insurance bill to settle.
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Last edited by Mr Tonka; 09-25-2013 at 05:59 PM.
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      09-25-2013, 11:10 PM   #9
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They will want to charge you list.... But if you tell them you don't have the money and need to work something out they will immediately take about 60% off of the bill.

My wife's mother had a bike accident and was in a coma for several days. Was flown from the scene to the hospital, all the works. Their bill for all services totaled $117,000 for the 8 day stay and flight.

At the time, her parents were recently laid off and only 3 weeks from being medicare eligible, so had no insurance. We called the hospital and told them that her parents had no money to pay the bill and that we would be paying for it but didn't have much money either, so we'd have to work something out. The lady on the phone said "can you pay $33k?" Yes, yes maim we can.

We did that on the advise of a family friend who is a hospital administrator. he said that nearly every hospital in the nation will take about 30% - 40% of the total non insurance bill to settle.
Yes - absolutely. Many hospitals also have "sliding scale" billing, where if you can't pay, they will discount based on your income. Every state also has Medicaid, for low income people, their children, and families. Seniors over 65 have Medicare. And many states have County hospitals, that rarely even try to collect from individuals. The government pays for 50+% of all healthcare in the US.
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      09-27-2013, 09:42 AM   #10
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We have the best procedures in the world, but access to those procedures is separate since not everybody can get that new-age cancer treatment. My wife who came from Japan hates to US medical system.
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      09-28-2013, 10:07 AM   #11
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We have the best procedures in the world, but access to those procedures is separate since not everybody can get that new-age cancer treatment. My wife who came from Japan hates to US medical system.
Not sure what new age cancer treatment you are talking about? Everyone should be able to get it, but your insurance may not pay for it. There is a lot of medical development in the US, and not all of it is proven. Therefore, the insurance companies often act like a filter in approving/denying coverage for certain procedures. A person might have one brain tumor in their life, whereas an insurance company will see thousands in a year: they have the data and tools to know which procedures have the best outcomes, and which docs and facilities do the best job. And that's who they sign contracts with, because the best outcome is often the cheapest for them in the long run, and keeps their customer (typically your employer) happy. Many people hate on insurers (and often rightfully so), but there is a benefit to sick people in this area.

Of course, now we have the government even further in the mix...

I haven't had actual experience with the Japanese system, but I do know that they collect statistics very differently than we do, so you can't really compare outcomes. The docs over there were having a problem some years ago because they wouldn't tell patients when they had a disease like cancer, because they didn't want to offend them. Japan does not count infant deaths that occur within 24 hours of birth in their infant mortality statistics. We do in the US, and it accounts for half of our infant mortality numbers.
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      09-28-2013, 06:43 PM   #12
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Not sure what new age cancer treatment you are talking about? Everyone should be able to get it, but your insurance may not pay for it. There is a lot of medical development in the US, and not all of it is proven. Therefore, the insurance companies often act like a filter in approving/denying coverage for certain procedures. A person might have one brain tumor in their life, whereas an insurance company will see thousands in a year: they have the data and tools to know which procedures have the best outcomes, and which docs and facilities do the best job. And that's who they sign contracts with, because the best outcome is often the cheapest for them in the long run, and keeps their customer (typically your employer) happy. Many people hate on insurers (and often rightfully so), but there is a benefit to sick people in this area.

Of course, now we have the government even further in the mix...

I haven't had actual experience with the Japanese system, but I do know that they collect statistics very differently than we do, so you can't really compare outcomes. The docs over there were having a problem some years ago because they wouldn't tell patients when they had a disease like cancer, because they didn't want to offend them. Japan does not count infant deaths that occur within 24 hours of birth in their infant mortality statistics. We do in the US, and it accounts for half of our infant mortality numbers.
When I use "new-age" I'm not refering to a specific treatment, just a broad term referring to our often world-leading development to fight diseases once thought incurable. Stats be damned, my wife's experience with both, and coming from a socialistic government leaves much to be desired with the US medical system. Subsidized pre-natal care is amazing too when we payed 500JPY for ultrasounds and other care, different reasons of course considering the rapidly aging population of that country. When I used the hospital for an examination it cost me about $500 USD without any insurance and a non-citizen, I can imagine it would have cost me 4 times as much if I went to Kaiser or some other hospital. Lunacy.
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      09-28-2013, 11:52 PM   #13
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Quote:
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When I use "new-age" I'm not refering to a specific treatment, just a broad term referring to our often world-leading development to fight diseases once thought incurable. Stats be damned, my wife's experience with both, and coming from a socialistic government leaves much to be desired with the US medical system. Subsidized pre-natal care is amazing too when we payed 500JPY for ultrasounds and other care, different reasons of course considering the rapidly aging population of that country. When I used the hospital for an examination it cost me about $500 USD without any insurance and a non-citizen, I can imagine it would have cost me 4 times as much if I went to Kaiser or some other hospital. Lunacy.
When I hear "new-age" I'm thinking magical crystals and tuning forks.
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      09-30-2013, 05:43 PM   #14
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-Sales taxes equal out to roughly 15% (varies but mostly between 13 to 15% in most populated provinces)
-Drivers licence 80$/year if you haven't lost any points.
-Plates/Registration +/- 320$/year (more if the engine is over 4.0L in displacement)
-Used cars are still taxed every time they are sold. So basically if the same car goes thru 10 owners, it's taxed 10 times.
-Eye care and dental care is NOT included in our healthcare. We pay for that, and honestly it's the most important because those are two things that EVERYBODY is going to need at one point in their life no matter what, whereas NOT everybody is going to need to go the emergency in their life.

1) Sales tax in Texas is 8.25%
2) Driver's license is $25/6 yrs
2) I paid ~$70 to renew my reg this year, + ~$30 for the state inspection.
3) Used car sales tax is 6.25% here
4) Eye and dental care aren't included, but I pay ~$16.50/month for the coverage through my employer's ins plan
5) And you are correct, no state income tax, which is one of the reasons I live in Tx. I feel sorry for my California brethren.

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      09-30-2013, 09:05 PM   #15
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Quote:
Originally Posted by G-Bus View Post
-Income tax rates Provincial (Quebec);
$41,095 or less 16%
More than $41,095 but not more than $82,190 20%
More than $82,190 But not more than $100,000 24%
More than $100,000 25.75%
-Income tax rate Federal;
15% on the first $43,561 of taxable income, +
22% on the next $43,562 of taxable income (on the portion of taxable income over $43,561 up to $87,123), +
26% on the next $47,931 of taxable income (on the portion of taxable income over $87,123 up to $135,054), +
29% of taxable income over $135,054.
You have to add both up, so for someone making, say 50k$ a year, which isn't all that much, you give 22% of it to the Federal Gov. and 20% to the Provincial Gov. which equals out to 44% OUT. That's almost HALF of your salary that you don't even get to see. When you make over 100k$ it's even close to 60%...

Now all the points are valid for most of Canada. I'm in Quebec so all of this is applicable here, not sure about the rest of Canada.
Let me just stop you right there. This tax analysis is definitely NOT valid for most of canada since you're quoting quebec taxes which is probably the most radically different province in the whole country (not to mention the colossal amount of debt Quebec is amassing just to keep doling out these perks). Many things are heavily subsidized in quebec which are not in other provinces which is the reason for those taxes.

I've lived and worked in both the US and Ontario and quite frankly the gross income tax rates are quite similar, maybe a little bit more in Ontario. Other provinces have lower taxes, just as other US states have lower or no state income taxes. In the end, if you compare two major financial cities like Toronto and New York, for someone earning 50-100k (in USD) you're paying around the same income tax. In Ontario you'd get basic healthcare through the provincial system and extra benefits from your employer (usually) while in the US basically all of your healthcare comes from your employer's health insurance (if you work for someone nice enough to provide it).

As for health care expenditure per capita in the US versus other countries - it is quite glaringly obvious the US system is inefficient and insurance companies are running amok but a lot of that can be explained by the excess supply of lawyers willing to litigate for little to no justifiable reason.
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      10-02-2013, 08:10 PM   #16
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Stats are very bad for the US healthcare system.

Very expensive (about twice as expensive as most develloped countries), yet it has very bad statistics on things like infant mortality, life expectancy etc. US classify as a "devellopping country" on most public health statistics.

As a foreigner living in the US, I also find the system to be very infuriating. In my country, I know the price of everything before hand. In the US, it's never really clear what is insured and what's not, and how much I'll end up paying. The bill shock is sometimes very displeasing. And I supposedly have an excellent insurance coverage (big public institution, coverage operated by BCBS). If you complain, provider and insurance keep bouncing the ball saying it's the other that's at fault, but in the end, I'm left with the tab.
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      10-03-2013, 06:55 AM   #17
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Population differences is the biggest problem with comparing the US to Canada or any of the Scandinavian countries.

Canada has a population of about 33 million whereas the US is over 300 million. In any case when it comes ton health care the US spends the most on end of life care. We really do pull out all the stops for the elderly. In addition we have a huge generation of people who are retiring. Their numbers and age are largely responsible for the increase in health insurance premiums over the past 10 years.

Canadians pay more in taxes without a doubt but your country is large and your population is small.
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      10-03-2013, 08:17 AM   #18
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Socom: don't get your point. What's matter is how much tax each person pay to support 1 elderly. So in essence the ration active/retired. Size of population or country surface doesn't matter. In most regard US population is younger than most countries with a working healthcare system. So that's no excuse really.
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      10-03-2013, 11:13 AM   #19
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Socom is saying that what you are doing is like comparing apples to mocking birds.

It's not an excuse, it's part of the problem. The US healthcare system has provisions that allow hospitals to keep elderly people alive beyond their useful time and bill the insurance companies $6000 a day to do so. That plays a large part in my insurance carrier making my CT scan cost $2000.

I don't mean to sound callus, but what business does the hospital have in recommending an 89 year old woman have surgery that may extend her life for a few months, maybe even a year or two, but WON'T improve her quality of life? Essentially enabling her to live for another year in and out of hospital care. It's not like she's going to get this operation and go play tennis afterwards. The operation only (possibly) allows her more time, but not better time. Essentially more time to accumulate hospital bills. If you're around hospital administration, these procedures to marginally extend life aren't offered to those without insurance. But if you have good insurance, you are more than welcome at most hospitals.
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      10-03-2013, 11:30 AM   #20
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Socom: don't get your point. What's matter is how much tax each person pay to support 1 elderly. So in essence the ration active/retired. Size of population or country surface doesn't matter. In most regard US population is younger than most countries with a working healthcare system. So that's no excuse really.
While the ratio is important (it has been getting worse and will only get better once the boomers die off) the cost is not linear. The administrative costs go up when you have a larger group to manage. It's just the way it is.

In addition it's harder to forecast costs because there are a lot more variables with larger less homogeneous populations. That's why comparing the costs in Canada to US is silly but politicians and policy wonks do it.

Personally the US problem was a long time coming. Besides population is just one piece. You have laws of supply and demand (i.e # of doctors, # of medical students) and external market forces such as high US prices for drugs which indirectly subsidizes the lower prices other countries pay.

I'm of the belief that other countries really don't want the US to be able to negotiate price with Big Pharma because it would have a negative impact upon their ability to keep their drug costs down.
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      10-03-2013, 11:54 AM   #21
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While the ratio is important (it has been getting worse and will only get better once the boomers die off) the cost is not linear. The administrative costs go up when you have a larger group to manage. It's just the way it is.
Maybe it is, but I doubt it is a determining factor. Demography is a more powerful factor, and countries like Germany or Japan have a very, very bad demographic profile.

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high US prices for drugs which indirectly subsidizes the lower prices other countries pay.

I'm of the belief that other countries really don't want the US to be able to negotiate price with Big Pharma because it would have a negative impact upon their ability to keep their drug costs down.
Most other rich countries have their own big-pharma industry complex. I'm not sure to what extent this statement reflect some truth (maybe for experimental treatments ?). Anyway, even in single payer countries, drugs that have no generic brand are expensive, that's just the way things are. The problem is more that the cost of doctors is outrageous (and that's maybe because payment system is so complex that every doctor needs 2 accountant specialists full time to deal with insurance claims etc, in France as an example, the doctor office is often a single person business, that's a lot of spared overhead because the billing system is streamlined through public single payer).
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      10-03-2013, 02:25 PM   #22
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Maybe it is, but I doubt it is a determining factor. Demography is a more powerful factor, and countries like Germany or Japan have a very, very bad demographic profile.


Most other rich countries have their own big-pharma industry complex. I'm not sure to what extent this statement reflect some truth (maybe for experimental treatments ?). Anyway, even in single payer countries, drugs that have no generic brand are expensive, that's just the way things are. The problem is more that the cost of doctors is outrageous (and that's maybe because payment system is so complex that every doctor needs 2 accountant specialists full time to deal with insurance claims etc, in France as an example, the doctor office is often a single person business, that's a lot of spared overhead because the billing system is streamlined through public single payer).
Of course they do. High taxes and higher incomes result in lower birth rates. They're all in trouble.


On a side note to the OP: About 20 percent of my father's patients were Canadian. He's a retired ophthalmologist and back in the 90's people had long waits for surgery in CA.
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