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Montana Carol

Active member
Jun 22, 2007
We're always told here in the U.S. that if we had Universal Healthcare it'd be like socialized medicine, i.e. we wouldn't be able to get the care we need, we'd be on a waiting list forever, we'd have no choices, etc.

What is the experience of the Canadian PALS/CALS on this forum? Can you get Rilutek and other medications free? What about assistive devices? Are you able to get MRIs, EMGs, and consultations with specialists in a reasonable time? Can you see the doctor of your choice, and get second opinions, without having to pay? How is the system financed in Canada?

I'm on Medicare, and have an excellent and very reasonable supplement insurance plan (Sterling Option I). It looks like I'll be able to get all the care I need (except nursing-home, if that ever becomes necessary) without undue expense. My tests and doctor visits have mostly been covered so far. But the cheapest I've found Rilutek is $500 per month, and that's from the Canadian Pharmacy. That's ridiculous, IMO. In the US, Humana shows the cost at $869/mo (60 tablets).

But for younger US patients, insurance costs are so high, and many don't have any coverage at all. I've read on this forum that an ALS diagnosed gets you on Medicare, but if you don't have a diagnosis you're up a creek. What are you middle-aged folks doing in the US? And what happens to the rest of the family when one parent is disabled, another is home being the caregiver, and nobody is working?

Is this an inappropriate thread for this forum? I don't mean to step on anybody's toes or get overly political. It just seems like a good place to ask these questions to see if we'd be better off with a healthcare system similar to Canada's.

I pay $45.00 for 3 month supply of Rilutek through Caremark mail order. I am on Medicare A & B and I carry my Ins. from my job. We have been blessed as far as everything medically has been covered and blessed from the ALS loan closet. My husband has been on disability since 1990 and I have been since March 07. It's very hard we have 5 children between us. Our youngest is 18 and just graduated. My husband has always had the rainy day plan financially and I thank God he did. Our home and vehicles were paid for when I was diagnosed with ALS. Having 5 kids help now that they are grown that helps with caregiving. We live in the US. I don't know how people do it my ole saying from my mom, where there's a will, there's a way & with alot of praying too.
Hope you're not in a rush. I'll get to how things work in Canada or at least Ontario shortly.
Wow, Rhonda! I'll have to check that Caremark source for Rilutek. Thanks! Is the $45.00 you pay only a co-pay after your work insurance? Medicare doesn't cover any of it, do they?
My work Insurance covers it with $45.00 co-pay. I'm not up on all the medicare stuff. I believe they have a drug plan and I didn't take it. To take medicare part B cost me a 100.00 a month plus I pay around 240.00 a month to continue my work Insurance. I feel blessed to have them both. A dear friend of mine that is battling cancer is over a half million dollars in debt with medical bills. Her and her husband both have their own businesses and the Insurance they purchased was not worth having when it came to paying for treatments. Plus it cost them around 800.00 a month. It is just not right.

We are in this predicament right now( in US). I've been a stay at home mom for 7 years and had a very nice career in technology prior. Now my husband has ALS. I spoke with an attorney the other day that deals with ALS, AIDS, Cancer patients and their difficulties obtaining disability about our situation. We now have no insurance for myself and my son and husband will have Medicare in September. His company has dropped the ball in getting disability going and now they are trying to shaft him on the pay out amount. What the H@#% are we supposed to do? If I go back to work I will not begin to earn the money I did before and we now live in a rural area where jobs are few and far between, not to mention low paying. I then will have to pay for child care and care for my husband. Boom, no money left over in the paycheck! I am 50 years old, you asked about the middle aged people and what are they doing - well, I just don't know yet. We can't even plan ahead right now. Sorry going on and on - the attorney said we were just going to have to make a major change in our life style, that it was a travesty that there is no system in place to help terminally disabled people and their families.

I could go on but don't want to bore you. I'm pretty pissed off right now.:evil:

Carol, this is a timely topic. I urge you all to see "Sicko" by Michael Moore. I have two brothers, many friends and lived myself in the US for 5 years so I have experience in both countries. In fact my daughter was engaged to a young man from Montana. It is a never ending source of amazement to me that one of the world's more affluent countries does not consider universal health care as a right of citizenship. In this respect, the US stands out as a glaring anomaly among the western nations. I believe it is unique in letting its citizens scramble to qualify for private health insurance if they are healthy enough and well-enough employed to manage to get it.

We in Canada were no better of until the 1960s (unless you lived in Saskatchewan where full medicare was extended to seniors and the disabled in the 1940s) when government funded universal medicare finally became available. It was a divisive issue at the time with conservatives talking darkly of the evils of socialized medicine and how doctors would become government employees and bureaucrats (and you know how lazy they are). You would be hard pressed to find many people today who want to go back to laissez-faire medicine. Even now there is variability in coverage between provinces. Drugs (except extremely expensive ones) are still the responsibility of the patient. Otherwise all doctors appointments, tests, treatments, hospital stays and surgeries are government funded. Patients are free to choose any doctor and indeed, as many as s/he wants or needs. For GPs, one can usually make an appointment within a week or so or the same day if it is urgent. For specialists, it make take longer although I can see my neurologist on very short notice. My rilutek is provided at no cost. The system is not perfect and there can be waits of several weeks or even months for some tests such as MRIs and EMGs. Like all countries we are wrestling with soaring health costs. But a significant cost of health care in the US must result from the overhead and administrative costs of implementing the many insurance plans. There is no such associated costs in Canada except for drug plans which are very straightforward.

In Ontario there is an employer health tax. It used to be paid by the individual but a bunch of years ago the gov't decided to get employers to pay a fee per hundred dollars of wages paid to employees. This in part funds the system. We can see whatever doctors we want but there are waits for specialists. My first Neuro visit was booked in June for Oct. But then I got 3 more opinions no problem. Emergency wait times are a problem because a lot of people go to emerg rather than a walk in clinic and then complain about 6 hour waits. Ambulance is a no hassle pick up but you get a bill later for $244 but some private Ins. will pay. New GP's are in short supply. We moved to a town of 30,000 2 years ago and the docs are not taking new patients. Our old Doc is 20 miles away which is no big deal unless it's an emergency then there's a hospital 12 minutes away.
Drugs cost but if you have no ins. there is a gov't plan that there is a deductible for. If your income is under $10K the deductible is $350 payable in 4 installments. If you make 100K the deductible is $8000 I think.
Depending on which assistive devices you need the gov't helps to pay. They paid $75% of my power chair. Some ins. cover the rest or the ALS Society of Ont. can help with part of it. The system isn't the greatest and has deteriorated in the last 10 years with less being covered but it is still better than some countries.
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Good Points! Thanks!

Thanks, John1 and all who have commented. I agree that one reason our insurance costs are so high here is the administrative cost of having so many insurance plans. When the US was considering Hillary's universal healthcare study back in 1993 or so, I read that a single-payer government plan like Medicare would cost 3% (of total costs, I think) to administer, whereas a proposed Blue Cross/Blue Shield version would entail about 9% for administrative expenses.

Do Canadian providers complain that they aren't earning as much as US doctors? I think doctors here believe they're entitled to make piles of money because that's our cultural tradition, and they cite their high student-loan balances and years of education -- although we also have doctors who work for non-profit religious and government agencies who contradict that mindset. I've heard a specialist and a physical therapist here whine that providers LOSE money on Medicare and Medicaid patients, and that the privately-insured patients are paying for those others (and of course people who pay high insurance costs are afraid it would be even worse with universal healthcare).

The cost of one of my MRIs was about $3000 at our small-town hospital; Medicare allowed $1600 and (along with our supplement policy) paid all but $160 which was our share. I find it hard to believe that the hospital is losing money on that transaction. They were booked up two weeks ahead for the MRI machine. I have an appointment at Virginia Mason in Seattle for further diagnosis, and they were booked out two months. Even further out at the University of Washington , but they didn't even accept our Medicare supplement plan for some reason, I was told.

Is the Canadian system funded by employer/employee payroll deductions, or what? In the US, working people are paying (7.3%? or more) for Social Security and Medicare, and the employer an equal amount. We Medicare members are paying over $90 a month this year, deducted from our Social Security check, and my Sterling Option I supplement is only costing $9.00 a month right now -- an unbelievably good plan designed for healthy people, which pays our health club dues as well as preventive dental and optical care, in addition to supplementing Medicare-covered expenses. We have to pay a small part of each doctor visit, etc, and a maximum of $1500 for a hospital stay.

If I have to switch to a plan more in keeping with my tentative ALS diagnosis, it'll cost about $120 a month, which is still a blessing, as Rhonda said about her relatively low premium. We each pay $17.10 for our Medicare drug plan, but I don't think it'll cover Rilutek at all. I still need to check more into that, I guess; but I'm not convinced Rilutek does enough good to justify any great expense, and then I hear it has side effects too. Is there a thread on that subject?

And what about nursing-home or home health aide care in Canada? Is that paid for by the government, too?

I've been an advocate of US universal healthcare for years, even though we had my husband's excellent union health insurance which covered almost all of my breast cancer care in 1990. I remember thinking then about all the people with catastrophic diseases who were without coverage, wondering how they could manage. Now it looks like maybe our country will actually implement universal healthcare when we get a new president, and I believe we'd all be better off if we had Medicare for everyone.

Sorry for this long post.
Al, thanks for your post about Canadian healthcare funding. It answered the question that I think I was typing in my chatty-cathy post above. Very informative. Any system is going to have its shortcomings, and both our countries need to do something about the skyrocketing healthcare and prescription costs overall. Carol
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