For me that would be $6k max, depending on how much we had already used this year for our out of pocket max. So no not 100k.

Sure, but you still get billed as an ER visit. I’m saying if you have a junk reason you get to go to the non-emergency department and if it takes 4 hours to get to you it takes 4 hours you shouldn’t have come to the hospital for your stubbed toe.

Currently, you could see the janitor and they would still bill as an ER visit.

Maine seems chock full of Canadians living here or visiting. I would hope those folks don't count as it would skew the data.

I was going to say for many patients any thing that lessens the chance they are going to have back surgery is probably a good thing :)

I believe what they did was say that any bankruptcy that had medical debt no matter the size of that debt was medical debt related. So if you had a $25 medical debt and you went bankrupt it was medical related. I will look for the article when I get home also.

True, but that would require changing the mindset of the patient population that comes to the ER. If you go into the ER, you have to be seen. Pretty much every ER is worried about an EMTALA violation. The majority of patients come to the ER for non-emergent stuff that should not be seen in the ER to start with. Plus, if they are Medicaid then the patient will be paying zero to very little out of pocket, meaning it will not matter (to them) if they are seen in a primary care doc's office or the ER.

What is profit margin or roi in private sector? How many middlemen/brokers?

How much is malpractice insurance relative to service? What percentage written off to indigents/bad debt.

Is there better way practically than fee for service?

I took the liberty of numbering your post to answer in chunks.

on #1 - are you asking about private insurance or private healthcare providers? Private insurance is very profitable. Just check out the public financials of any of the large insurers. I'll save you the search - Anthem posted 22.9 billion in gross revenue (premiums etc.) with 17.9 billion in cost of revenue last quarter alone. I.e., their "gross margin" was almost 23%. Net net, after paying for all of their costs they still managed a 4.6% net income margin. Multiply everything by 4 for annual figures. Last year they had almost 13billion in SG&A expenses...or 14% of revenues. Medicare, for comparison (and taking care of SICKER patients) is somewhere around 2% for admin I think. In other words - almost 20% of everything you pay for in healthcare is going to administration & profit at insurance companies. Woooo hoooo - market based solutions!

#2 - malpractice is expensive but honestly not all that much. Just looked over to my other screen. One of our subsidiaries has 17 docs. Malpractice was 700K for the year. 40K/per physician (some of this is for the facility too...nurses etc....but I spread over the doctor population). We pay physicians 10x that amount in salaries & bennies on average. Real bad debt writeoffs are about 3% of net revenue. True indigents who are not totally homeless and paperwork free have Medicaid. Medicaid does pay less than cost but the pieces we writeoff for that are not considered bad debts. They're contractual adjustments. I'm not chasing that right now - point is that if everyone paid Medicare rates, we'd be breaking even.

#3 - some form of pop health management or other. A hybrid system where care is managed by feds based on acuity with a paralel PRIVATE system that's fee for service. Something like every other developed nation has. Hard to do here when half the population believes complete fables about 'market based solutions' and the other half ignores that extremely powerful players are happy with the way things are (insurance companies, physicians, med schools, pharmaceuticals, equipment and durable medical goods manufacturers). To a lesser degree, even hospitals do alright this way. It's a stupidly complicated system that rewards administrators like me at the expense of nurses who scoop up shit all day but that's where we're at.

My younger sister has been nurse for about 3 years...in surgical suite and you are right she doesn't make squat, works long hours and on call fairly frequently. She once shared the markup on biologicals it was incredible.

Imagine how much we could save if all those at trump rallies would lose a few pounds.

Thanks for info.

Honest question: how is Canada going to deal with reduced revenues and increased expenditures as its population ages (fyi, Canada has a much larger demographic problem than the U.S.)

https://www.macleans.ca/...-government-coffers/

How long will Alberta continue to subsidize the rest of the country before its residents say "enough" and declare independence (which is legal and comparatively simple in Canada)? That doesn't seem like an outlandish proposition either, given the wild rise the Wild Rose Party has seen.

Boy you didn't even wait a day before dipping into that wacky tabacky did you?

I don't smoke and I don't drink. Never have and never will.

The wildrose party was only around for nine years before they merged with the conservatives. In the last election they had less than 25% of the vote. IMO their extreme right wing views reached their maximum number of voters before people left for the conservatives. Including 9 elected MLAs who crossed the floor.

As to your revenue vs expenditures question, I have no idea. I'd think we'd raise more revenue via taxes, increase immigration, and cut expenditures.

And I really don't see many people seriously talking about Alberta leaving Canada despite the unfair equalization payments. We'd rather change the equalization calculations and criteria to be more fair to all .