Health care: Shriner hospitals in trouble

[Darth Wong]

http://www.cnn.com/2009/HEALTH/06/08/sh ... index.html

Possible closure of six free Shriners hospitals scares parents
By Jason Hanna
CNN

(CNN) -- Matt Aldridge would have trouble contemplating life without the Shriners Hospital for Children in Greenville, South Carolina.

Aldridge, 28, and his 21-month-old daughter, Maddie, were born without shinbones. Both had their legs amputated at Shriners near their first birthdays. Like all care given to youths admitted to any of North America's 22 Shriners Hospitals, their surgeries and follow-up treatments were free to them.

Aldridge estimates the care he received through his teens in the Shriners' system -- which admits children irrespective of their parents' income -- cost hundreds of thousands of dollars, approaching the lifetime limits of some insurance policies.

Now, he and his wife, Renee, take Maddie to Greenville -- about a 90-minute drive from their South Carolina home -- at least every six weeks, partly for treatment of a hip condition.

Without Shriners' cover-all-costs policy, the family would be in serious trouble, said Aldridge, who works at a Wal-Mart's cell phone connection center. Renee is a stay-at-home mother, and the family doesn't have private medical insurance.

"If it weren't for Shriners, we'd be financially devastated," Matt Aldridge said. "With just the care Maddie has received already, we probably would be bankrupt."

For the Aldridges and many other families, accessing care from Shriners may get a lot more difficult.

The system's board says it may ask the fraternity's membership in July for authority to close six hospitals -- including the one in Greenville -- largely because the endowment fund that supports the hospitals dropped from $8.5 billion to $5.2 billion over the last year as the stock market plummeted.

The others that could close are in Erie, Pennsylvania; Shreveport, Louisiana; Spokane, Washington; Springfield, Massachusetts; and Galveston, Texas. The Galveston hospital's operations have been suspended since Hurricane Ike flooded it last year.

Deflated investments aren't the only reason the fund has dropped. The hospitals normally operate with donations and the fund's interest, but the system's $856 million 2009 budget is outpacing both, causing the hospitals to take about $1 million per day from the fund, said Ralph Semb, president and CEO of Shriners Hospitals.

Other proposals from the system's board would close just one hospital or none, but slash spending systemwide. Leaders also are exploring other options, such as partnering with non-Shriners hospitals. But one way or another, the system must cut spending by about 30 percent to survive, Semb said.

"If we do nothing, every hospital would have to cut 25 to 30 percent from their budgets, which in effect would shut about six of them anyway, because they couldn't give the services they've been giving," Semb said.

Still, the hospitals can't close without consent of the fraternity's membership. Two-thirds of the roughly 1,400 representatives at the group's July 6-8 Imperial Council Session in San Antonio, Texas, would have to vote for it.

History shows that might be difficult. Members, some of whom transport children to hospitals themselves, killed a 2003 proposal to close the hospital in Minneapolis, Minnesota, after a similar market downturn.

"I don't think it will happen. I don't think it should happen," said Carl V. Nielsen, a 40-year Shriner and a board member for the Minneapolis hospital, which is not on the current possible-closure list. "That would leave large areas of the country without a Shriners hospital, and the cost of transportation of the patients back and forth [to the remaining hospitals] would be too great."

Shriners Hospitals, which deals with certain specialties up to age 18, have treated hundreds of thousands of children free of charge since the first facility opened in Shreveport in 1922. Most offer orthopedic care. Four, including the Galveston hospital, care for children who are burned. One of those facilities, in Sacramento, California, is treating a few children burned in Friday's day care center fire in northern Mexico.

The Greenville hospital, which generally draws children from six states, gets about 900 inpatients and about 1,100 outpatient visits yearly, according to Rod Brown, the chairman of that hospital's board of governors.

Since news of the possible closures broke, many -- including some Shriners and people who've used the hospitals -- have spoken out in hopes of keeping the facilities open. Hundreds have turned out for rallies in some of the cities. Several "save Shriners Hospital" pages on Facebook call on readers to support fundraisers.

Families who lose a nearby Shriners hospital -- even those who have insurance -- would be in trouble, said Nielsen, an Iowa resident, retired attorney and former state legislator.

"Say you've got a series of operations to do on the child, and it's going to cost $100,000. Even with the good insurance policies, the families still have to pay 20 percent on that, and that's more money than most have stashed away," he said.

The Aldridges have more surgeries in their future. In addition to being born without her shinbones, Maddie has only eight fingers. She will need operations to make her hands more efficient.

If the Greenville facility were to close, the family would think about moving to Kentucky, where the next nearest Shriners hospital is. Or, they would stay and drive eight hours to the Kentucky facility.

Option No. 1 would take the lifelong South Carolina residents from friends and relatives. The other would mean more missed days at work and school for the family, which also includes Maddie's 3-year-old sister.

In any event, the family says it won't consider taking Maddie out of the Shriners system.

Matt Aldridge, who took up competitive power-lifting thanks in part to encouragement from Shriners staff and competed in the 2004 Paralympic Games in Greece, said the system gives top-notch care.

"Not only is it a financial thing, but it's also quality of care," said Aldridge, who became a Shriner himself in part because of the care he received. "Shriners doctors are considered to be the foremost experts in what they treat."

Semb said some of the six hospitals -- which he said were chosen because they were relatively underutilized -- could stay open if they strike a partnership with non-Shriners facilities. In such a deal, Shriners doctors would perform major surgery at the partner hospital, and the partner would bill the patients' insurance if they have it. Follow-up care would be done at the Shriners facility, still free of charge.

Nielsen and other Shriners are proposing an alternative for the July meeting: Let Shriners hospitals themselves accept insurance or Medicaid from the families who have it, but cover the co-pays and deductibles.

Semb said the idea has some merit, but he cautioned that to accept insurance and Medicaid, the hospitals would subject themselves to more federal oversight and possibly curtail their ability to treat patients as they see fit.

Meanwhile, Renee Aldridge is circulating petitions against the closures and intends to deliver them to the San Antonio meeting. Wide swaths of the country shouldn't be deprived of the expertise and the free treatment that Shriners doctors give, she said.

"Some may be able to go to another place, but a lot of doctors won't put the time and care in that Shriners does," she said.

Lifetime limits in the low hundreds of thousands? TWENTY PERCENT co-pays? Is this for real? How can anyone feel even remotely secure if he is "insured" under such conditions? I honestly don't understand how people in the world's wealthiest nation can put up with this. Not everyone is lucky enough to get free care from these Shriner folks, as welcome as their help is.

[The Spartan]

Sometimes even that is not enough. Link to SDN post

The gist of that link is that an insurance company is going to let a three year old (as of that posting) die because he had exceeded the cap on his parents insurance due to his severe anemia and that's with a $1 million limit. I don't know what has become of him since, but I don't imagine he's going to be in good shape even assuming he's still alive. This came up a couple years back from tWat's "golden insurance" remark or whatever the hell he called it.

The point I'm attempting to make is that people don't put nearly enough thought into just what that cap means and are as often as not wholly ignorant of just what kind of expenses a hospital incurs during the course of almost any treatment, particularly surgeries and the like. And that's assuming that they actually have other options available to them that they can afford. Considering that the provider in the OP works at a Wal-Mart facility, I'm going to go out on a limb and assume that they don't.

[Darth Wong]

We really need to make a library thread linking to all of the threads we've had discussing stories like this.

[Surlethe]

Lifetime limits in the low hundreds of thousands? TWENTY PERCENT co-pays? Is this for real? How can anyone feel even remotely secure if he is "insured" under such conditions? I honestly don't understand how people in the world's wealthiest nation can put up with this. Not everyone is lucky enough to get free care from these Shriner folks, as welcome as their help is.

Not just for real, they're normal. My wife and I are insured under a student policy available through our university. For health providers that are in-network, we just have a 10% co-pay; for a provider out-of-network, we have a 30% co-pay. The insurance also doesn't cover hospital stays or treatments defined as 'unnecessary' (like that second ultrasound my wife had). Agreement all around is that we got a pretty decent deal for $1750 a year (that's for both of us, on separate student plans).

Edit: Terms of our particular student health insurance plan can be found here.

Edit2: Sorry, it's $1800 for both of us, not $1600. I was remembering the first digit, not the rounded figure.

[Bluewolf]

I agree, we should make a Healthcare resource thread, it'd be useful to gather all those links.

[Sea Skimmer]

Lifetime limits in the low hundreds of thousands? TWENTY PERCENT co-pays? Is this for real? How can anyone feel even remotely secure if he is "insured" under such conditions?

On some policies sure, but each of the hundreds of US health insurance providers offers dozens of different policies. It’s the freedom of capitalist choice at work. So many choices you literally cannot tell the difference between most of them.

In fact the lifetime limits on some policies are much lower then that; as low as 20-50,000 dollars and co pays can be as high as 50%. However a policy with a 250,000 dollar limit and say a 5% co pay can have a low premium, less then 75 bucks a month in some instances, and for a healthy young person that’s not really a bad deal. It will cover the vast majority of even serious injuries and shield you from near certain bankruptcy. You just don’t want to have to keep that kind of coverage for life. What your actual rates are going to be though will vary enormously depending on what your job is (office jobs among those which are bad, too many fat smokers) and how old you are. A 45 year old would easily pay three times as much as what I do for the same coverage as a 23 year old non smoking white male.

You also actually tend to get screwed when you buy health insurance as part of a group policy, like from a workplace because your risk level is now being averaged against the risk of everyone else in the group and that almost always will be a negative against you. Only by the employer paying a large portion does it become favorable.

[MarshalPurnell]

If you watch the commercials and arguments against some kind of government health-care program, they are ready to stress the scenario of "government bureaucrats denying care." They often bring in Canadians to provide anecdotal testimony about how their public system denied them an operation or procedure, and doctors from abroad to testify about how nationalization has destroyed "choice" in health care. This bogeyman has gone unanswered, partly because some rationing of care will happen under any public system of health care to keep it financially viable and therefore it can't quite be called out as a damned lie. They also tend to attribute the absolute best standard of care in our present system (which is pretty exceptional) as a baseline for how the system is "supposed" to work, without providing the sort of context of how such care is out of reach for most Americans without exceptional insurance coverage, enormous amounts of money, or running into bankruptcy.

People selling universal health care in the US have been enormously incompetent at countering this message. They tend to stress their limited, moderate aims of insuring everyone has some form of coverage, or at most claim that universal health care will be better than the present system in some vague sense. People who are not presently struggling with major health issues are apt to be complacent and to take the present system for granted, without recognizing any of its flaws, and are therefore vulnerable to the scaremongering of forces opposed to any government role in health care. Simply put most Americans do not realize how broken the system really is and won't until they're facing the enormous bills and looming bankruptcy of a disaster. They don't think that their health care is already going to be rationed, not in the public interest, but by private sector bureaucrats out to insure healthy profits for their bottom line. The structural-economic benefits of relieving employers of the need to provide expensive private health insurance by granting universal health care under the government is never even brought up in the debate. That we already spend enormous sums of money on the inefficiently structure Medicare and Medicaid, and that requiring hospitals to eat the costs of emergency room visitors that can't pay, is not used to show how absurd the compromises of our present system are. In short there are a great many arguments that can be used to undermine the "raa, raa free market good, government evil" approach taken by opponents of universal health care that simply are not made.

It may be because these arguments are frankly highly negative about our present system. It may be thought politically that attacking the practices of the private systems will turn people off, or something like that. But unless there is real alarm on the part of the American people they will complacently cling to their illusions rather than think seriously about the future. The Democrats could be a lot more aggressive about pushing a single-payer system with the GOP largely lamed, but they're afraid of creating some kind of groundswell that will come back in 2010, so far as I can tell; and this is a terrible mistake, since they probably will not have a better opportunity in the future. The hybrid government insurance program is the sort of expensive, inefficient compromise that will probably resolve nothing and see health care costs continue to rise by not dealing with the underlying problem that health care costs in America have just ballooned to an unsustainable level for the individual and for the country.

[Darth Wong]

I think that the weakness of UHC proponents in the US can be boiled down to their reluctance to admit that socializing it is the best solution. They keep pushing these klunky public/private hybrid systems which are meant to insure everyone while also ensuring that these private health insurance companies continue to operate as before. A lot of the arguments they could use against the anti-UHC fanatics are stillborn in America because they involve standing up against the "government always bad, free enterprise always good" paradigm.

[Gambler]

I live in germany and I am insured under a student health insurance plan. The rates are set by the government and they were just slightly lowered. I pay about 780€ a year and the co-pay is about 10€ each trimester. I'm so glad we don't have the US healthcare system. I wouldn't be able to afford 20 or 30% co-pays on the cancer treatment I am receiving.

[Lost Soal]

From my limited understanding of US health insurance, meaning correct me if I'm wrong, there should be an easy counter to the arguments.
A US man and a UK man both in their 40's making the equivalent of $25,000 p/a contract cancer.
UK worker receives treatment, free of charge, recovers and is able to continue with his life.
US worker can't afford the treatment under his policy, he dies.

May need a little refinement to be truly accurate but the basic premise is sound. Right?

[Stark]

Wouldn't the US person be sunk into debt paying for treatment and then go onto the poverty-welfare, now that they (and possibly their whole family) has been destroyed financially?

[Tanasinn]

The more of the middle class that finds itself without hospitals, the better. It's hard to pretend the system works when you're told to fuck off until you bring more money.

They will get angry, and we might finally see our countrymen shaking off their hysterics over socialized medicine.

[Sea Skimmer]

Wouldn't the US person be sunk into debt paying for treatment and then go onto the poverty-welfare, now that they (and possibly their whole family) has been destroyed financially?

No sometimes they would just die. If you can’t pay anything and you don’t have insurance you just won’t be able to get certain expensive treatments at all. Hospitals must provide emergency stabilizing care and that kind of thing, but they don’t have to give you 100,000 dollars in chemotherapy (no idea if that’s what it costs but just go with it) even if they do diagnose you with cancer. Organ transplants are another thing you wont be able to get, but then the supply of organs is always much smaller then the demand already.

Most people either have some coverage or can pay something, or already can get some help from the government, so they can get treatment and will most likely be run into bankruptcy by it if it’s going to involve long term care.

One big problem though is people run up a significant debt, and then just don’t do anything about it because they don’t think they can. Then eventually the hospital is going to go after them. If you agree to pay something, even if it will never pay off the debt if you lived 100 years, you can often avoid all that.

[Rahvin]

For myself and my girlfriend (she's listed as my domestic partner - she needed health care, and we're not married, but we qualified for DP) I pay US$190.60 every 2 weeks. That's a little short of US$5000/year. That also includes dental and vision, though those two cost almost nothing ($2-6 per month for the two of us total).

My job pays an additional amount. Since domestic partnerships aren't given the same tax benefits as marriage, I also have to pay taxes on the company's portion of my girlfriend's coverage, and my portion comes out as after-tax (the part that covers just myself comes out pre-tax, and the company's portion is also Federally tax-exempt).

I pay $20 for a visit to the doctor's office (30% after the deductible if I go out-of-network).

Mandatory generic drugs are $5. Formulary prescriptions are $25, non-formulary are $40. That's all for 30-day supplies - and very few of the medications we need are available as generics.

For labwork, x-rays, etc that don't require a deductible, I pay 10% in-network, 30% out-of-network.

I pay 10% after a deductible for any surgeries, maternity care, "nutritional supplements (adminsitered by tubal feeding)," etc. Yes, they specifically noted the cost of a feeding tube.

Lifetime maximum is $5,000,000 per person. That should be enough, but really, I don't like the idea of a cap on insurance coverage. What if I develop a life-threatening, untreatable disease that's controllable with expensive medication and/or surgeries, and I go over the limit? What good did my health insurance do me then if I'm still eventually left either destitute or dead?

I'd pay 10% after deductible for a maximum of 30 days/year for inpatient mental health coverage; for outpatient coverage I'd pay 30% with a maximum of 60 total visits per year.

This is pretty good from what I've experienced here in the states at other companies. The premiums are higher, but that's because of the domestic partner part - if it were only me, I'd only pay around US$78 per pay period for the same coverage.

Even so, we pay about $80/month for prescription medications.

What's it actually like with a proper national healthcare system? Do you pay anything to visit the doctor? What about prescriptions, or surgeries?

[Broomstick]

Lifetime limits in the low hundreds of thousands?

Yes.

At a job I applied for last year they were crowing about their "excellent" benefits - which had an annual cap of $3,500! That's bullshit.

TWENTY PERCENT co-pays? Is this for real?

Oh yes, that's actually considered quite good for hospital/in-patient services. I've seen 50% co-pays, and even policies were out of network co-pays were 75-80%. There are a some wretched, wretched policies out there.

How can anyone feel even remotely secure if he is "insured" under such conditions? I honestly don't understand how people in the world's wealthiest nation can put up with this. Not everyone is lucky enough to get free care from these Shriner folks, as welcome as their help is.

It's because they don't know and don't understand. The majority of people won't have a million-dollar illness or injury in their lifetimes, so they blithely go along with their lives never realizing the size of the holes in their safety net. All too often, when disaster does hit they suddenly realize their coverage is nowhere near what they thought it was. In addition, the most common outcome for people with a severe illness or injury is that they lose their jobs (being unable to work long enough for the employer to fire them) and thus lose their health insurance. If that person is the breadwinner an entire family can lose all coverage.

Really, it makes me sick. I worked for the fuckers for 13 years because it was the ONLY way I could get me and mine covered. I so very much want a REAL UHC system in this country!

[Broomstick]

On some policies sure, but each of the hundreds of US health insurance providers offers dozens of different policies. It’s the freedom of capitalist choice at work. So many choices you literally cannot tell the difference between most of them.

WHAT choice? Who the hell does the choosing? YOU? No way - your employer does the choosing in most cases. The dirty, dirty truth is that the "consumer" gets little or no choice at all. You see the doctors that have signed onto your health plan. If they leave either you change or you bleed money. What fucking choice is that?

However a policy with a 250,000 dollar limit and say a 5% co pay can have a low premium, less then 75 bucks a month in some instances, and for a healthy young person that’s not really a bad deal. It will cover the vast majority of even serious injuries and shield you from near certain bankruptcy.

Bullshit. You're just so used to the US system you don't realize how shitty a deal that is.

A $250,000 limit is nothing, I spit on it >PTUI!<. That's shit. A million dollars should be the minimum and even that isn't really sufficient.

You just don’t want to have to keep that kind of coverage for life.

Don't worry - you won't the way things are going. In a few years you won't have any at all.

What your actual rates are going to be though will vary enormously depending on what your job is (office jobs among those which are bad, too many fat smokers) and how old you are. A 45 year old would easily pay three times as much as what I do for the same coverage as a 23 year old non smoking white male.

Right, and women of ALL ages pay two to three times as much no matter HOW healthy they are! I have NEVER seen a policy that covered a woman of ANY age for $75/month anywhere - and I used to work in the fucking industry! And buddy, you won't be 23 forever - your rates WILL go up, and go up steeply starting around age 25-30 no matter how healthy you are. You have ONE health "condition" - it could by anything, fucking hayfever would do - and your rates will go up. Better never have high blood pressure, gallbladder problems, or toenail fungus. Ever. Oh, and when you hit 40 and develop a little larger prostate than before? You're fucked.

You also actually tend to get screwed when you buy health insurance as part of a group policy, like from a workplace because your risk level is now being averaged against the risk of everyone else in the group and that almost always will be a negative against you. Only by the employer paying a large portion does it become favorable.

The usual whine "oh, the healthy are subsidizing the sick! Oh, oh, how AWFUL!" That what the fuck insurance is! That's how it works. And why do we buy it? Because no one is guaranteed perfect health for life.

[Surlethe]

Oh, my wife just reminded me that the coverage cap is $100,000 per illness/injury and it doesn't cover regular doctor's appointments. We're relatively healthy adults, so we're comfortable with the risk, but we have no choice but to live with it. Reading Mike's astonishment, I can't help but realize just how foreign feeling securely insured would be - this (excellent!) coverage may not constantly dominate my thoughts, but at the back of my mind I'm aware that if we have a really bad medical problem in our family, we're utterly fucked.

My dad also pointed out to me once that (bless him, he's conservative) the worst that could happen is we would run up the deductible, run through our savings, sell our car, computer, and furniture, and then qualify for medicare, so it's not like we'd be totally screwed. Family safety nets would probably kick in before that happened, though.

It occurs to me now that, as young adults who don't have much in the way of illiquid assets (i.e., we're not property owners), we are relatively secure precisely because we don't have that far to fall. If we do eventually have to qualify for honest-to-God medicaid (as opposed to pregnancy medicaid and SCHIP, which thank God we did qualify for, so we're not going to be ruined by NICU costs), we're not going to have to sell our house, or move from an upper middle-class lifestyle to an impoverished lower-class lifestyle in the space of six months; we'll just transition from student-class to slightly-more-impoverished student-class.

[Surlethe]

A $250,000 limit is nothing

I'll bet that's why the premium's so low - the company knows they'll be able to profit in almost all of his possible health scenarios, so they can afford to drop the price he pays for coverage.

[Minischoles]

What's it actually like with a proper national healthcare system? Do you pay anything to visit the doctor? What about prescriptions, or surgeries?

You only pay for everything indirectly (anytime you get a paycheck, a percentage of it goes towards your National Insurance), which you don't pay as a student, as a pensioner or if you're unemployed obviously. You are never actually paying beyond being taxed throughout your working lifetime, but for that you get essentially unlimited care (the more expensive drugs and treatments can be denied in some cases), you can visit a Doctor with a complaint at anytime, your surgery and hospital stay will never cost you anything extra.
Prescriptions do cost a very small sum (£7.20 as of this April, so about $11), but even then theres a ton of exemptions to that; people over sixty, children under sixteen (or under nineteen if the child is still in full time education), patients with certain medical conditions and those with low incomes are all exempt from paying even that nominal charge. And thats regardless of the medicine you're being given, it can be a simple migraine tablet or a cancer medication, its still the same.

[Darth Wong]

I am never, never, ever moving to the United States.

[Rahvin]

What's it actually like with a proper national healthcare system? Do you pay anything to visit the doctor? What about prescriptions, or surgeries?

You only pay for everything indirectly (anytime you get a paycheck, a percentage of it goes towards your National Insurance), which you don't pay as a student, as a pensioner or if you're unemployed obviously. You are never actually paying beyond being taxed throughout your working lifetime, but for that you get essentially unlimited care (the more expensive drugs and treatments can be denied in some cases), you can visit a Doctor with a complaint at anytime, your surgery and hospital stay will never cost you anything extra.
Prescriptions do cost a very small sum (£7.20 as of this April, so about $11), but even then theres a ton of exemptions to that; people over sixty, children under sixteen (or under nineteen if the child is still in full time education), patients with certain medical conditions and those with low incomes are all exempt from paying even that nominal charge. And thats regardless of the medicine you're being given, it can be a simple migraine tablet or a cancer medication, its still the same.

To say that such a system would be "life-changing" is an understatement.

EDIT: It's striking that what I consider "pretty good coverage" compared to what else I've seen (and the plan I posted is the best,most expensive plan offered by my employer) here in the US makes non-Americans cringe in revulsion at how backwards we are. If moving to a more civilized country were possible in the near future...

[aerius]

I am never, never, ever moving to the United States.

No kidding. I was discussing US healthcare with one of my friends a while back and we came to the conclusion that there's no way in hell either one of us would move to the States unless we had at least $10 million lying around to cover medical expenses.

[Darth Wong]

What's it actually like with a proper national healthcare system? Do you pay anything to visit the doctor? What about prescriptions, or surgeries?

Doctor visits are free. I call up my doctor for an appointment, I usually get one within a few days or even the same day if it's an acute problem, but if I want a full physical I have to wait because they're long appointments and take lower priority. When I show up at the doctor's office, I show him my Ontario Health Card, and that's it. I have never given the doctor so much as one dollar out of my own pocket.

There are no lifetime limits on usage. A few years ago someone floated a political proposal to have $3 co-pays per doctor visits in order to discourage over-use of the system, but it was unpopular and got shot down.

Surgeries are the same way: if the surgery is actually medically necessary, you show the hospital your Ontario Health Card and that's the end of it. No money out of pocket. I had a hernia surgery (at the Shouldice Clinic) and a vasectomy done that way. In both cases, I had to wait a few months to book the surgery: a fact that American right-wingers would no doubt pounce on. But they were non-emergency surgeries, so they got pushed down the priority list. The night I went into Shouldice, the guy sharing my room had been examined earlier the same day and got booked in for emergency surgery because his case required it. Queue jumping in our system is based on medical need, not wealth.

Prescriptions cost money, unless you have a private insurance plan (we still have private insurance plans here, and that's the sort of thing they cover, as well as cosmetic dentistry; medically necessary dentistry is covered by the government). There are needs-based assistance plans for prescription medicine, and government price controls to keep the medications affordable.

[Stark]

No sometimes they would just die. If you can’t pay anything and you don’t have insurance you just won’t be able to get certain expensive treatments at all. Hospitals must provide emergency stabilizing care and that kind of thing, but they don’t have to give you 100,000 dollars in chemotherapy (no idea if that’s what it costs but just go with it) even if they do diagnose you with cancer. Organ transplants are another thing you wont be able to get, but then the supply of organs is always much smaller then the demand already.

Whoa, really? You mean, the doctor comes in and says 'pay or we stop treatment'? That's pretty stunning.

Rahvin, AU has a different system to Canada (because the nation has been on a privatisation kick for decades), so we pay a trivial fee for a doctor's visit. There's a giant list of drugs heavily subsidised by the health system, and pensioners get even more discounts. Things like diagnostic imaging appears to be free - I certainly never end up paying for them. Surgery/dental through the public system is also free, and due to competition with 'free but waiting', the private system here is far cheaper than in America.

[The Duchess of Zeon]

I am never, never, ever moving to the United States.

Why do you think one of my side goals while working toward my degree is to learn French? I don't want to raise a family under these conditions, ever, and I'd sort of like to adopt kids someday. But I don't think anyone can in good conscience have children while living in the United States. You have an obligation to take care of them and if you're an educated professional who is employable in another country that means you need to leave the states to make sure you have enough health insurance to cover any one of these contingencies so that you don't ruin the future of your other children because you can't pay for them to go to school--remember how murderously expensive US education is--to try and save the life of your child for whom you insurance limits have been exceeded. Be it Canada or France I'm prepared to accept substantially lower income to get a job overseas in a country with real protections against this--you're also not going to have to deal with the ridiculous American labour laws which basically let companies work people to death.