Reply #73: that's the Canadian option! and I see Canadian input is needed here ;)

[iverglas]

I voted for option 1 WITH the understanding that people could purchase insurance for elective surgeries/treatments.
As Kucinich explained insurance companies would not be able to compete for basic health coverage, necessary surgeries etc. but they would be able to offer plans for cosmetic reasons.

That is EXACTLY the Canadian system.

The public plan covers medically necessary services. Anything else, you can pay for yourself, however you like. But insurers may not sell coverage for the services covered by the public plan, and private insurance may not be used to pay for them.

I had three little lumps removed from my leg a year ago. My primary care physician and the dermatologist were completely sure they were in no way problematic (but of course the tissue was examined anyway). They just irritated the hell out of me and i wanted them gone. (The dermatologist cautioned me that I would have scars ... as compared to lumps, I guess ... and I figured oh well, there went my career as an ankle model.) I paid the guy $200, and they're gone. I'm self-employed, and don't have supplemental insurancy.

My good friend is having her second bunion surgery this fall. Bunion surgery is regarded as ineffective by the medical profession, apparently, and isn't covered by the public plan. (I have another friend who had it done, and she concurs.) My friend is a public servant and has a whopping gold-plated supplemental insurance plan, premiums employer/employee paid, through her employment. It's all covered.

Vasectomies are covered by the plan here. Want a vasectomy reversed, you pay for it yourself, or through supplemental insurance, if it's covered.

I had a biopsy about 15 years ago that required three nights in hospital. I desperately wanted my own room, so when I won the lottery for the private room, I paid the extra $60 a night out of my pocket. Most supplemental plans will cover that. When I broke my foot about 10 years ago, the orthopaedic surgeon inquired whether I had supplemental insurance, because if I did I could get the fibreglas cast instead of the plaster, i.e. I'd be able to bathe. I said no, but how much was it. He said $100. I said I want it, I'll pay for it. He said no, you don't want to do that, and I figured I looked low-income, which I wasn't, so I insisted. Gimme it. He said no, really, you don't need a cast. Just be careful for a few weeks. So I was.

My father went into hospital 4 years ago -- went directly to ER on a Friday evening on return to Canada from several weeks in Florida, was examined, was given an appointment with an orthopaedic surgeon for Monday, went back to ER on Sunday because of leg pain, fearing a clot, lung x-ray revealed spots, had biopsy a few days later and remained in hospital for the next six weeks. Everything - absolutely everything, from kleenexes to medications to daily visits from internist, orthopaedic surgeon and oncologist - was covered by the plan. We paid for parking. (We Canadians always seem to mention that we pay for parking. It's the only thing we can think of that we pay for, and it's expensive.) And then from when he was delivered to my sister's home 30 miles away by ambulance until he died two days later, everything was covered - ambulance, fancy inflatable hospital bed, morphine drip, little accessories like lip moisteners, visiting nurse, doctor on call. I paid for an Atavan prescription, $25 out of pocket, because the sublingual version wasn't on the plan; otherwise, it might have cost the seniors' $2 co-pay, if the pharmacy didn't waive it.


If you can buy insurance for the same services as are covered by the universal plan, you have a two-tier system. The reason that this is usually permitted is that doctors and other providers will then provide a different level of service for people with private insurance that pays them more, and keeps the rich from whining -- faster appointments with specialists, better room service meals in hospital, etc. Since there is in fact absolutely no expansion in the services available within the system, all this does is bump people in the public plan farther down the line. Obviously. And if the rich happen to become disenchanted with the taxes they are paying so the poor can have health care ... well, you get what the NHS was in the UK in the early 90s. A shabby, crappy system that didn't deliver.


My understanding of Option 1 in this poll is that it refers not to a universal plan with supplemental insurance for non-covered, non-medically necessary services, but to a two-tier system in which people can go public or go private for their insurance, and presumably for their services (if they want to pay out of pocket rather than via insurance; this became common in the UK when the NHS was trashed).

This is what Edwards' proposal is: a two-tier system combined with a requirement that everyone obtain insurance somewhere, whether in or out of the public plan.

I would never accept it for myself, and I vehemently oppose any attempt to introduce a second tier into the Canadian system. But if I were in the US and had no insurance at all, and this would give me access to the public plan, I might think it was a good first step.

But if I were picking my ideal system, I can't imagine why I would pick that one. Unless I were seriously short-sightedly self-interested.