HMOs vs. Medicare

[Biblio Bibuli]

We all know how stingy our Medicare can be in prescribing expensive diagnostic tests, compared to the U.S. HMOs.

Is it true that when an American health insurer denies your request for an MRI, PET or CT scan and you go ahead and pay for these tests out of your own pocket, if the test turns out positive they'll reimburse you pronto, with an attached letter of apology?

Why isn't our Medicare doing that?

[geoffrey]

Why?

Because paying for things in Canada related to your health is a taboo subject and any further discussion on this at the political level by any party would be marked as "Americanisation." And everything American is bad, so HMO style is bad.

Come on now, get with the times.

--

Realistically, I see it like this. You shouldn't be denied the test in the first place, both systems are failures in that regard. Any waitlist or denial of any test that has effects on someone's well being is unacceptable and should not be tolerated in either Canada or the US.

[Michael Hardner]

Who is being denied diagnostic tests ? I feel the opposite is true - that I have been sent for needless tests in the past. What are the experiences of others here ?

[geoffrey]

Who is being denied diagnostic tests ? I feel the opposite is true - that I have been sent for needless tests in the past. What are the experiences of others here ?

My sister has yet to be diagnosed, even though she's had serious lung symptoms over the last two years. She was initially denied a physical lung exam (laparoscopy procedure), but due to consistant pressure by my family, the doctor ceded to the 'unnessesscary' procedure in anger. The results came back with some interesting evidence that has helped with the treatment of the symptoms, and lead towards a more complete understanding of a possible diagnosis. In the meantime, however, she has suffered greatly, and the hospitals refuse to deal with the problem and solve it.

We are fortunate enough to be able to afford US treatment, and we are exploring that option in the coming months, as two years of suffering for a teenager through high school days is unacceptable. My family is not for 'for-profit' healthcare, but we are left no other choice by our failed system in Canada.

If a diagnosis is quickly found by US doctors, the Canadian health care system should be responsible for the costs of the diagnosis and treatment, plus a reasonable amount of compensation for the suffering caused by their negligence.

However, we are unlikely to file any lawsuit, that's counter-productive. Further lobbying will be done though to push the Canadian government into single-payer, privately delivered services... were treatment levels have been proven to be greater with no change to the universiality of the system.

It just angers me that some Canadians can't afford US treatment, and instead, will suffer for the rest of their life, all for a failed political dogma.

[Michael Hardner]

If a diagnosis is quickly found by US doctors, the Canadian health care system should be responsible for the costs of the diagnosis and treatment, plus a reasonable amount of compensation for the suffering caused by their negligence.

I agree.

However, we are unlikely to file any lawsuit, that's counter-productive. Further lobbying will be done though to push the Canadian government into single-payer, privately delivered services... were treatment levels have been proven to be greater with no change to the universiality of the system.

It just angers me that some Canadians can't afford US treatment, and instead, will suffer for the rest of their life, all for a failed political dogma.

It's a more efficient way to manage healthcare than a pure market system - better care across the board and cheaper - when managed well. The current government is committed to socialized healthcare, though with more market presence than before, so the political dogma has at least partly succeeded.

[Wilber]

One reason US doctors use so many tests is that they are scared stiff of malpractice litigation. Personally I am not a big fan of the HMO system.

I am also not a big fan of the way our system is being run. A big story in BC at the moment is that the ER doctors in Vancouver General and Royal Columbian hospitals have stated in writing that they have lost confidence in the ER system in their hospitals. Not because of the ER's themselves but because there are no hospital beds to move the ER patients into for very long periods of time. They point out that elective surgeries are being done in public hospitals while emergency patients needing those beds lay out in halls and doorways. The obvious question that many of them ask is why are we doing elective surgeries in public hospitals? The answer of course is that to do them in privately set up clinics drives the anti private crowd nuts, even if those surgeries are paid for by Medicare.

Never let common sense and the welfare of the sick get in the way of a good dogma.

[geoffrey]

Well its not even the case of elective surgeries, ones that people have to pay for.

If you can claim that having small breasts is causing you emotional harm, then breast implants are a neccessary surgery, and you get in ahead of the 'elective' sinus procedure that allows someone to live migraine free and able to work. There was a case of this with a teenager in Quebec who wasn't happen with her breasts so the taxpayers funded a boob job. I'm sure many such cases happen, just we don't care about all the BS that goes on.

Read up on Sweden or France if you want effective health care. Both are pseudosocialist welfare loving hippie states, and yet they have user fees and private provision of care. And guess what else the have? No waiting lists, and much better quality care and access to tests and diagnostic services. Not to mention that they are universal in nature, no one has ever been denied care.

It's sad so many Canadians think Tommy Douglas is a hero. He's actually been as close to the worst thing thats happened to Canada since its conception.

[margrace]

Who is being denied diagnostic tests ? I feel the opposite is true - that I have been sent for needless tests in the past. What are the experiences of others here ?

My sister has yet to be diagnosed, even though she's had serious lung symptoms over the last two years. She was initially denied a physical lung exam (laparoscopy procedure), but due to consistant pressure by my family, the doctor ceded to the 'unnessesscary' procedure in anger. The results came back with some interesting evidence that has helped with the treatment of the symptoms, and lead towards a more complete understanding of a possible diagnosis. In the meantime, however, she has suffered greatly, and the hospitals refuse to deal with the problem and solve it.

We are fortunate enough to be able to afford US treatment, and we are exploring that option in the coming months, as two years of suffering for a teenager through high school days is unacceptable. My family is not for 'for-profit' healthcare, but we are left no other choice by our failed system in Canada.

If a diagnosis is quickly found by US doctors, the Canadian health care system should be responsible for the costs of the diagnosis and treatment, plus a reasonable amount of compensation for the suffering caused by their negligence.

However, we are unlikely to file any lawsuit, that's counter-productive. Further lobbying will be done though to push the Canadian government into single-payer, privately delivered services... were treatment levels have been proven to be greater with no change to the universiality of the system.

It just angers me that some Canadians can't afford US treatment, and instead, will suffer for the rest of their life, all for a failed political dogma.

As I understand it the ordering of tests is up to the doctor, not health care. When a doctor refuses to order tests there should be some way around it. You should be able to get a second opinion on this.

I have heard of this happening and it has nothing to to with our health care situation and all to do with incompetant doctors or doctors with an agenda. A lot of doctors would love to see our health care privitized then they could get a lot more for their services than they do now. We should really look at these situations and see who is to blame.

[margrace]

One reason US doctors use so many tests is that they are scared stiff of malpractice litigation. Personally I am not a big fan of the HMO system.

I am also not a big fan of the way our system is being run. A big story in BC at the moment is that the ER doctors in Vancouver General and Royal Columbian hospitals have stated in writing that they have lost confidence in the ER system in their hospitals. Not because of the ER's themselves but because there are no hospital beds to move the ER patients into for very long periods of time. They point out that elective surgeries are being done in public hospitals while emergency patients needing those beds lay out in halls and doorways. The obvious question that many of them ask is why are we doing elective surgeries in public hospitals? The answer of course is that to do them in privately set up clinics drives the anti private crowd nuts, even if those surgeries are paid for by Medicare.

Never let common sense and the welfare of the sick get in the way of a good dogma.

Once again a lot of doctors have always been against our health system, they could make a lot more money if they didn't have to go through the goverment system that puts a cap on their charges. Why don't people realize this.

[margrace]

Well its not even the case of elective surgeries, ones that people have to pay for.

If you can claim that having small breasts is causing you emotional harm, then breast implants are a neccessary surgery, and you get in ahead of the 'elective' sinus procedure that allows someone to live migraine free and able to work. There was a case of this with a teenager in Quebec who wasn't happen with her breasts so the taxpayers funded a boob job. I'm sure many such cases happen, just we don't care about all the BS that goes on.

Read up on Sweden or France if you want effective health care. Both are pseudosocialist welfare loving hippie states, and yet they have user fees and private provision of care. And guess what else the have? No waiting lists, and much better quality care and access to tests and diagnostic services. Not to mention that they are universal in nature, no one has ever been denied care.

It's sad so many Canadians think Tommy Douglas is a hero. He's actually been as close to the worst thing thats happened to Canada since its conception.

How many people in Canada can afford to go to a private clinic and pay for their services? If doctors are allowed to set up private clinic then who will look after the general public. There is a lot of miss information on here. That is why doctors have lobbied so hard to keep the number of trained doctor limited. A shortage of doctors is to their advantage.

[Wilber]

One reason US doctors use so many tests is that they are scared stiff of malpractice litigation. Personally I am not a big fan of the HMO system.

I am also not a big fan of the way our system is being run. A big story in BC at the moment is that the ER doctors in Vancouver General and Royal Columbian hospitals have stated in writing that they have lost confidence in the ER system in their hospitals. Not because of the ER's themselves but because there are no hospital beds to move the ER patients into for very long periods of time. They point out that elective surgeries are being done in public hospitals while emergency patients needing those beds lay out in halls and doorways. The obvious question that many of them ask is why are we doing elective surgeries in public hospitals? The answer of course is that to do them in privately set up clinics drives the anti private crowd nuts, even if those surgeries are paid for by Medicare.

Never let common sense and the welfare of the sick get in the way of a good dogma.

Once again a lot of doctors have always been against our health system, they could make a lot more money if they didn't have to go through the goverment system that puts a cap on their charges. Why don't people realize this.

Nothing to do with it. Why did I have to take up a hospital bed for the better part of a day recently for minor surgery that could have been done just as well in a privately run clinic but paid for by Medicare. Why did I have to take up a hospital bed for nearly half a day for a colonoscopy when it could have been done just as well in a privately operated clinic and paid for by Medicare. Those beds could have been much better utilized for people who were really sick or injured. Where does it say that our Medicare system always has to use government built, government run facilities to do their job?

Your GP is a private businessman operating out of a privately run facility under Medicare. Most medical lab work is done by private labs and paid for by Medicare or group medical plans. The only question here should be, who pays the bills, not who provides the service. That should be done by those who can provide the best service for the customer, who is the patient. God forbid that someone could do that and actually make dollar out of it. That would be absolutely immoral. Far worse than people lying around in emergency wards for days.

Private businesses actually know to the nickel what it costs to provide their services. If they don't, they go broke. Government run businesses don't have that incentive.

[Biblio Bibuli]

You shouldn't be denied the test in the first place, both systems are failures in that regard.

Sure you should! If the cost is a thousand bucks and only one in a hundred will turn out positive, that's too much money.

But if on average one in 5 will turn out positive ... even the Canadian Medicare people will give you a prompt date with a CT scanner.

My point is .... if they are willing to spend $5000 to catch one culprit .... why wouldn't they offer me my measilly $ 700 back? ( I bargained them down.)

[geoffrey]

Well its not even the case of elective surgeries, ones that people have to pay for.

If you can claim that having small breasts is causing you emotional harm, then breast implants are a neccessary surgery, and you get in ahead of the 'elective' sinus procedure that allows someone to live migraine free and able to work. There was a case of this with a teenager in Quebec who wasn't happen with her breasts so the taxpayers funded a boob job. I'm sure many such cases happen, just we don't care about all the BS that goes on.

Read up on Sweden or France if you want effective health care. Both are pseudosocialist welfare loving hippie states, and yet they have user fees and private provision of care. And guess what else the have? No waiting lists, and much better quality care and access to tests and diagnostic services. Not to mention that they are universal in nature, no one has ever been denied care.

It's sad so many Canadians think Tommy Douglas is a hero. He's actually been as close to the worst thing thats happened to Canada since its conception.

How many people in Canada can afford to go to a private clinic and pay for their services? If doctors are allowed to set up private clinic then who will look after the general public. There is a lot of miss information on here. That is why doctors have lobbied so hard to keep the number of trained doctor limited. A shortage of doctors is to their advantage.

How many people in Canada can die and suffer before you change your dogmatic view of health care?

There is alot of misinformation coming from your side too. If the government is covering the costs of private delivery, everyone gets access to world quality care. User fees prevent idiots from going in and getting splinters removed at a cost of hundreds of dollars to the taxpayer.

Like I said, France and Sweden have private delivery, public single-payer systems. No waiting lists, top notch care.

Instead, we hold on to some ridiculous socialist view (only Cuba and North Korea use our system) and watch as children, adults, seniors suffer and die... all for political points.

You've been convinced by the 'Friends of Medicare.' I wonder when we will have a 'Friends of Patients' group.

Medicare is no friend to the sick in Canada.

[margrace]

Well its not even the case of elective surgeries, ones that people have to pay for.

If you can claim that having small breasts is causing you emotional harm, then breast implants are a neccessary surgery, and you get in ahead of the 'elective' sinus procedure that allows someone to live migraine free and able to work. There was a case of this with a teenager in Quebec who wasn't happen with her breasts so the taxpayers funded a boob job. I'm sure many such cases happen, just we don't care about all the BS that goes on.

Read up on Sweden or France if you want effective health care. Both are pseudosocialist welfare loving hippie states, and yet they have user fees and private provision of care. And guess what else the have? No waiting lists, and much better quality care and access to tests and diagnostic services. Not to mention that they are universal in nature, no one has ever been denied care.

It's sad so many Canadians think Tommy Douglas is a hero. He's actually been as close to the worst thing thats happened to Canada since its conception.

How many people in Canada can afford to go to a private clinic and pay for their services? If doctors are allowed to set up private clinic then who will look after the general public. There is a lot of miss information on here. That is why doctors have lobbied so hard to keep the number of trained doctor limited. A shortage of doctors is to their advantage.

How many people in Canada can die and suffer before you change your dogmatic view of health care?

There is alot of misinformation coming from your side too. If the government is covering the costs of private delivery, everyone gets access to world quality care. User fees prevent idiots from going in and getting splinters removed at a cost of hundreds of dollars to the taxpayer.

Like I said, France and Sweden have private delivery, public single-payer systems. No waiting lists, top notch care.

Instead, we hold on to some ridiculous socialist view (only Cuba and North Korea use our system) and watch as children, adults, seniors suffer and die... all for political points.

You've been convinced by the 'Friends of Medicare.' I wonder when we will have a 'Friends of Patients' group.

Medicare is no friend to the sick in Canada.

Just a little reminder, my daughter is alive and well today because she received a bone marrow transplant which would have cost a minimum of $250,000 US up front if we had private health care. Her benefits were taken away from her by Harris's reform type government in Ontario so she had to rely on OHIP. She is back nursing full time and is still working as a casual worker with no benefits. So much for our great Reform type governments.

Its very easy to judge when you haven't been there. Her father developed leukemia in 1964 and lived 10 days after he was diagonosed.

My daughter got the best care there was in McMaster Hospital in Hamilton.

The problem with Health Care is two fold, the main one being greed. We live in an area where care is immediate because doctors like our area, we are getting the ones to whom quality of life is more important thatn money. When people put the possession of Hummers over care of lest fortunate citizens then there is something dreadfully wrong with their thinking.

[scribblet]

Well its not even the case of elective surgeries, ones that people have to pay for.

How many people in Canada can die and suffer before you change your dogmatic view of health care?

There is alot of misinformation coming from your side too. If the government is covering the costs of private delivery, everyone gets access to world quality care. User fees prevent idiots from going in and getting splinters removed at a cost of hundreds of dollars to the taxpayer.

Like I said, France and Sweden have private delivery, public single-payer systems. No waiting lists, top notch care.

Instead, we hold on to some ridiculous socialist view (only Cuba and North Korea use our system) and watch as children, adults, seniors suffer and die... all for political points.

You've been convinced by the 'Friends of Medicare.' I wonder when we will have a 'Friends of Patients' group.

Medicare is no friend to the sick in Canada.

Indeed. If a patient needs a diagnostic procedure e.g. maybe an MRI or CAT scan, the doctor won't do that right away because of the expense. They will start with the least expensive diagnostic procedure e.g. x-ray or bone scan for instance. If they get their diagnosis with that, then they've saved money on the more expensive treatment. If not, they move up to the next procedure and so on. I guess its russian roulette with the patient, my doctor told me that a couple of years ago. I had a problem while in the U.S. and the doctor wanted me to have a CAT scan immediately, my insurance wouldn't pay for it and chose to fly me home instead. My doctor here wouldn't order a cat scan, had to have an x-ray , then a bone scan, the bone scan showed nothing, so next was a CAT... They take a chance that the cheapest procedure first will pay off. Go figure..

I don't like HMOs either, but those dogmatically opposed to any form of choice seem to think that they will end up having to 'pay' for their health care. This is fear mongering and we know that this won't happen, so sob stories don't cut it, people will still be looked after.

[scribblet]

Just as an aside, maybe how doctor's set up their appointments need to be looked at. I like my doctor, but if I need to see him about two issues, then I have to make two appointments. I have an appointment for my general physical coming up, but he won't see me then for my weight loss check-up, have to make my regular monthly appointment, so two in one month when it could easily be done as part of the check-up.

Can't see him in one appointment for an eye infection and ask about a re-occurrence of a basel cell on my face - two appointments. All billed to OHIP of course.

[margrace]

Just as an aside, maybe how doctor's set up their appointments need to be looked at. I like my doctor, but if I need to see him about two issues, then I have to make two appointments. I have an appointment for my general physical coming up, but he won't see me then for my weight loss check-up, have to make my regular monthly appointment, so two in one month when it could easily be done as part of the check-up.

Can't see him in one appointment for an eye infection and ask about a re-occurrence of a basel cell on my face - two appointments. All billed to OHIP of course.

Sob stories indeed, have you ever lost a child, I lost a Grandchild at 21, a husband at29, so how are you doing. Without the OHIP I would never have paid off the bills for my Husband.

I lived when there was no OHIP and I hear a lot of young spoiled brats on here who have always had everything handed to them complaining because they have to pay some taxes. It makes me sick

[scribblet]

Just as an aside, maybe how doctor's set up their appointments need to be looked at. I like my doctor, but if I need to see him about two issues, then I have to make two appointments. I have an appointment for my general physical coming up, but he won't see me then for my weight loss check-up, have to make my regular monthly appointment, so two in one month when it could easily be done as part of the check-up.

Can't see him in one appointment for an eye infection and ask about a re-occurrence of a basel cell on my face - two appointments. All billed to OHIP of course.

Sob stories indeed, have you ever lost a child, I lost a Grandchild at 21, a husband at29, so how are you doing. Without the OHIP I would never have paid off the bills for my Husband.

I lived when there was no OHIP and I hear a lot of young spoiled brats on here who have always had everything handed to them complaining because they have to pay some taxes. It makes me sick

Maybe I have, and so did I (live when there was no OHIP ) and OHIP doesn't pay for funerals. No one was suggesting we do away with OHIP, why do you continually suggest that or twist things? Personally I've never had anything handed to me, I came from a very poor background were both parents were adamantly NDP, but they never whined and complained. I paid for my own education and worked hard for everything I have today thank you very much, it wasn't handed to me.

It makes me sick that people seem to think that everyone else should look after them in perpetuity.

[Renegade]

Just as an aside, maybe how doctor's set up their appointments need to be looked at. I like my doctor, but if I need to see him about two issues, then I have to make two appointments. I have an appointment for my general physical coming up, but he won't see me then for my weight loss check-up, have to make my regular monthly appointment, so two in one month when it could easily be done as part of the check-up.

Can't see him in one appointment for an eye infection and ask about a re-occurrence of a basel cell on my face - two appointments. All billed to OHIP of course.

Sob stories indeed, have you ever lost a child, I lost a Grandchild at 21, a husband at29, so how are you doing. Without the OHIP I would never have paid off the bills for my Husband.

I lived when there was no OHIP and I hear a lot of young spoiled brats on here who have always had everything handed to them complaining because they have to pay some taxes. It makes me sick

margrace, you point out the need for a health insurance plan. I don't think anyone disputes that. What I question is why there needs to be a plan funded from taxes. If your point is that people get medical services so they shouldn't complain about the taxes. I think that is a very simplistic view.

People care that they are getting the most for their money regardless if it is paid via taxes or directly via a health insurance premium. Many people pay far more in premiums than they get in benefits. It sounds like you and your family are one of those who has benefited by getting far more in benefits than has paid in pemiums or taxes, and so you consider the system valuable. But the beneifts you have derived have come at a cost to other taxpayers.

[Drea]

margrace, you point out the need for a health insurance plan. I don't think anyone disputes that. What I question is why there needs to be a plan funded from taxes.

Where, if not from taxes, would funding for our health insurance come from?

If your point is that people get medical services so they shouldn't complain about the taxes. I think that is a very simplistic view.

People care that they are getting the most for their money regardless if it is paid via taxes or directly via a health insurance premium. Many people pay far more in premiums than they get in benefits. It sounds like you and your family are one of those who has benefited by getting far more in benefits than has paid in pemiums or taxes, and so you consider the system valuable. But the beneifts you have derived have come at a cost to other taxpayers.

It's insurance, just like any other insurance. I've insured my vehicle for the past 25 years and have only used it once. I'm sure I've paid out way more than I've used.

I go to the doctor once a year but pay premiums and taxes the same as the person who goes once a week. I'm not disturbed by this. Why? Because if I get cancer or some other disease, I am covered because I've paid into my insurance.

[Renegade]

Where, if not from taxes, would funding for our health insurance come from?

My preference would be to fund it from a health insurance premium as opposed to general income and sales taxes.

It's insurance, just like any other insurance. I've insured my vehicle for the past 25 years and have only used it once. I'm sure I've paid out way more than I've used.

I go to the doctor once a year but pay premiums and taxes the same as the person who goes once a week. I'm not disturbed by this. Why? Because if I get cancer or some other disease, I am covered because I've paid into my insurance.

Agreed, but if it's insurance it should follow the principles of insurance. Which means premiums are based upon risk and history. If you got into a lot of accidents, your auto premium would go up. Similarly, if you have and accident free record, your premiums would stay low or lower. So if you are at high risk, due to age, or health history or other risk factors, you should pay more as with insurance.

There are other ways in which it should be modeled after insurance. For example, there should be a deductable which discourages frivolious use. Also, you should have some say in the level of coverage as you do with auto insurance.

[geoffrey]

Where, if not from taxes, would funding for our health insurance come from?

Personally, I see some value in universiality, so I do think taxes are reasonable to cover those that are actually disadvantaged, say below $24,000 in household income.

Other than that, it should be somewhat premium based, so we all pitch $100 a month or what not. (Remember our tax bills would be reduced about 1/3 by that move so you'd have alot more money each month)

We also could generate a small amount of revenue through small user fees... say $20 a visit to the doc and $40 to the emergency room. Like I said before, a large part of the problem with our health care system is people making ridiculous trips to the ER for colds, or going to their doctor to have hangnails removed. Small user fees would end that without denying anyone care.

You and I are paying for it Drea, one way or another. It doesn't change if we pay it off our paycheque or pay it off our paycheque in taxes.

It's insurance, just like any other insurance. I've insured my vehicle for the past 25 years and have only used it once. I'm sure I've paid out way more than I've used.

I go to the doctor once a year but pay premiums and taxes the same as the person who goes once a week. I'm not disturbed by this. Why? Because if I get cancer or some other disease, I am covered because I've paid into my insurance.

No one is against having insurance. The question is why can't we have the insurance system set up differently. Some people think you should buy your health insurance like your car insurance. The American way for example (though lots of countries use this system). The problem with this, is that if you have enough accidents, you can't really get car insurance anymore, you'd be denied or it would cost incrediable amounts to insure. We can't have our sick people denied insurance coverage and left to die.

Personally, I don't think we need to change the insurance system (besides premiums and user-fees) in Canada, we need to change delivery. Private competition in the health care sector, as firms battle for our services through top notch service, is what we need. All paid for by a single payer system.

Of course those like margrace will come out saying I want to dismantle Canada or something by saying that. But lets be realistic, our system doesn't work now, people have to wait. Why not try another approach, another approach where no one is left behind either, no one is jumping ques.

[Wilber]

I think the great majority of Canadians want a universal system where no one is denied access to health care. I do think that if we are going to continue to have one, people will have to park their prejudices and take a good hard honest look at how we can accomplish it. Otherwise it will just continue to degenerate.

[Biblio Bibuli]

You shouldn't be denied the test in the first place.

My point is ....

However, the main point of my thread was to try, yet again, to knock into as many people's heads as I can the simple fact that Medicare's main reason for shunning the early diagnosis of some cancers in older adults is for one very very simple reason .... it is much cheaper to treat once the cancer is in full bloom.

So Harper now continues in the Liberals' footsteps by pretending that hips & knees are Medicare's biggest problems, followed by waiting times for treatments of diseases of His choosing.

Ever since the great Pierre Trudeau's reign this criminal behavior grew by leaps and bounds .... and the only person I fully trust not to stoop to this "money saving" scam is another great man, Michael Ignatieff.

GO MICHAEL GO!

[scribblet]

I think the great majority of Canadians want a universal system where no one is denied access to health care. I do think that if we are going to continue to have one, people will have to park their prejudices and take a good hard honest look at how we can accomplish it. Otherwise it will just continue to degenerate.

Exactly. MacLeans Magazine last week did an article on the proliferation of private health care, there is certainly more around than I had thought. No HMOs involved so that bogeyman doesn't fly, if you can afford it, you pay, that simple.