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August 25, 2005

INTERNATIONAL/PHYSICIANS: Canadian doctors going home means the US sucks, n'est-ce pas?

This one I find hilarious and gives me great deal of personal satisfaction. The pro-American health care system, "it's the finest on earth crowd" goes on and on about how terrible the Canadian system is and how all the doctors are leaving. In fact it was that sentiment especially from the wonderful, but confused, Sydney Smith over at Medpundit that inspired my "Oh Canada" tome.  (Actually I re-read "Oh Canada" the other day and it's a pretty damn good piece of analysis if I say so myself).

Syd was basically saying that all the doctors were leaving cos they hated the clinical restrictions of the single payer system and wanted to move to the glorious homeland of free-choice medical practice and CABGs for 97 year olds. I showed pretty conclusively using actual real life data that a) very few doctors were leaving Canada for the US, and that b) if they were leaving it wasn't that surprising as they get paid about twice as much by sneaking below the 49th parallel.

Well now we have more actual statistics and real data that shows that more Canadian doctors are heading back to Canada than are leaving -- and this was in 2004 when hockey was on strike so there was no real reason to go to Canada! The numbers are:

Canada has seen more doctors returning than leaving for the first time in 30 years, a report by the Canadian Institute for Health Information (CIHI) shows. The report, released Wednesday, says that between 2000 and 2004,the number of physicians leaving Canada declined by 38 percent. In 2004, 317 physicians returned to Canada and 262 left. That was a drop from 2000, when 420 doctors left the country and a significant decrease from the peak of 771 physicians who moved abroad in 1994.

I'm looking forward to the barrage of articles from the know-it all alleged "free-market" crowd who get spoon-fed rubbish by Frasier, PRI, Manhattan et al offering their apologies to the Canadians and admitting that their system is better than the one down here.  After all the alleged rush of Canadian doctors to the US was absolute proof in their mind that the reverse was true.

I'm waiting, I'm waiting....

August 25, 2005 in International, Physicians, Policy, Policy/Politics | Permalink

Comments

Like this?

David Gratzer, a Toronto physician affiliated with the Manhattan Institute, calculates that a Canadian earning $35,000 a year pays a stunning $7,350 in health-care taxes.

OR

The average Canadian waits 17.9 weeks between the time a patient makes an appointment to see a general practitioner and when he then sees a specialist.
He will then be treated by a system that ranks 13th out of 22 advanced countries in access to MRI technology; 17th out of 21 in access to CT scanners and seventh out of 22 in access to radiation machines.

http://www.ncpa.org/newdpd/dpdarticle.php?article_id=2112

The Canadian Supreme Court's decision should lead to successful challenges to similar laws in other provinces. While last week the court stayed the impact of its ruling in Quebec for a year, a nationwide debate on why Canada is the only country other than Cuba and North Korea to ban private insurance and private care has finally broken out, says Fund.

XXXXXXXX

Of course Democrats in CA want to outlaw private insurance exactly like Canada, Cuba and North Korea.

Today in history: August 25, 1814 - British Burn Washington To The Ground


Posted by: Ron Greiner | Aug 25, 2005 7:03:38 AM

Ron, if you could please provide the data linking MRI or CT access to outcomes... I'm having trouble finding that.

Posted by: Graham | Aug 25, 2005 7:13:13 AM

That 17.9 weeks waiting time could be why Canadians live longer than their cousins to the south. I've always thought that specialists were bad for your health. Like my Pa never used to say, avoid doctors unless it's broken or bleeding and you'll live longer.

Posted by: Brak | Aug 25, 2005 7:38:42 AM

I knew Matt didn't want to help America--he's just like all those other British who want to burn down Washington. I'll bet you didn't know that Tony Blair's cigarette lighter was confiscated just before his recent press conference with Bush. With their warm beer and their Saving the Queen--well, ya can't turn your back on 'em. Not for a second.

LOL, Ron is reduced to quoting "facts" from the WSJ's op-ed page. I like how the linked op-ed said Canada's care isn't cheap, and to prove this point compared it only to the OECD countries with universal health insurance. Golly gee, why didn't they compare it to America?

I completely fail to understand where the $7300 in health care taxes came from when Canadian costs per capita are less than $3k. Maybe the Canadians have a super-regressive tax system?

And lord knows, in America we couldn't possibly get those specialist referral wait times down. Not even if we continued to spend $4900 per capita to the Canadians' $2800 (2001). And um, about 2/3 of our docs were specialists compared to fewer than half of Canada's docs.

You know, Ron, your lack of faith in American ingenuity and know-how and ability to do things better than anyone else in the entire world is really distressing.

Right now, America is doing way better at delivering care than anyone could reasonably expect, given that we've got the most inefficient system in the world, with all kinds of insurance middlemen taking a cut for their profit and making it so hard for sick people to get care and for doctors and hospitals to give it to them without going bankrupt.

I think that if America had Canada's system, we'd end up with a medical system that was much better than Canada's system--we wouldn't only make it possible for everyone, sick and poor to see a doctor and get the care they needed while saving huge sums of money by cutting out the insurance middlemen, but we'd also be willing to spend what it took to make it a much more efficient system that had shorter wait times and had more great machines like CT scanners, etc, if that was really important to us. Because we're AMERICANS and We Can Do It Better!

Posted by: theorajones | Aug 25, 2005 8:01:57 AM

Graham,

Are you saying that Canada doesn't need medical equipment?

My brother had a broken neck and x-rays determined he needed surgery but after the MRI he decided not to have surgery. I could link you to him if you want.

Posted by: Ron Greiner | Aug 25, 2005 8:09:48 AM

theorjones,

I know you like that Democratic single-payer (unconstitutional) plan that is the buzz in California. But do you really think the USA would be better at Socialism than say the Soviets?

Posted by: Ron Greiner | Aug 25, 2005 8:17:59 AM

Ron, we're better at capitalism than the Russians are, so why wouldn't we be better at socialism? Why do you have so little faith in America?

I know nothing about the plan in California that you're referring to. I thought we were talking about Canadian doctors fleeing the US and going back to Canada. Which is, you know, upsetting, because America is better. But of course it's their choice--I mean, love it or leave it, right?

I just really resent the implication that if we had the same system as Canada, we wouldn't do a better job of it. Of course we would!

I'm not saying we should copy Canada's system, but I think it's really unfair that people keep talking about how much cheaper it is than ours and how it takes care of everyone and what no one talks about is how, duh, in Canada you don't have insurance companies that take a share of the profits! Of course it's cheaper! It's a totally unfair advantage. I mean, obviously if we had their system I think we could certainly do everything they do--we could totally make it possible for everyone to get the care they needed--and also we could cut down on waits.

Posted by: theorajones | Aug 25, 2005 8:42:24 AM

theorajones,

The Canadian courts have just ruled that the Canadian laws for their "Medicare" is unconstitutional. I notice you don't discuss that topic. Don't you think your Socialistic panacea would be unconstitutional here in America too?

Granted, here in America it is also illegal to sell insurance to someone over the age of 65. So maybe these guys at the NCPA should say - "Why is it that Canada is the only country that bans private insurance except Cuba, North Korea and the USA for citizens over the age of 65."

I would suspect that Medicare in America is probably unconstitutional too if we thought about it or took it to the Supreme Court.

Posted by: Ron Greiner | Aug 25, 2005 9:01:23 AM

What's at issue here is that real world outcomes are butting up against ideology (or in the case of Ron, his business).

While it's not perfect, Canada's (or other nation's) healthcare system produces better health for a larger portion of its population at a lower per capita cost than does the US's.

That Canada does this in a way that tries to universalize the quaility and access that it provides to all of its citizens goes against the ideology that the free market (i.e. individual circumstances) should dictate access and quality of care.

While the "free" market works for many things, healthcare isn't one of them.

If someone from a someplace you don't admire does something better than you, do you dismiss the achievement based on who they are and where they're from or do you try to understand how and why they're doing it better? Or do you do the opposite out of blind ideology?

Posted by: matt | Aug 25, 2005 9:08:53 AM

"I just really resent the implication that if we had the same system as Canada, we wouldn't do a better job of it. Of course we would!"

The more equal geographic distribution of people in the US would allow the US to do a better job than Canada with its health system. Access in Toronto, Vancouver, and Montreal isn't the problem... the 30% of the population scattered across the 99% of other territory is.

But I guess those people should just fend for themselves and pay whatever the market dictates for care... if the market even cares to support healthcare access in those rural markets.

Posted by: matt | Aug 25, 2005 9:15:40 AM

I live in the United States. I have health insurance. I work for a medical school. We have multi-month waits to see anyone for anything here. I don't understand why people keep bringing up supposedly long wait times for non-emergency care in other countries when the waits are just as long in the USA---even for people working for and insured by a medical school!

Posted by: Michael Pereckas | Aug 25, 2005 9:37:45 AM

Michael,

The nurses who are employed by your medical school will be put to a short COBRA for insurance termination if they get ovarian cancer and can't work. Being employed by a hospital means nothing.

I don't think real world outcomes are butting up to anything Matthew. I believe DiamondCluster International's press release that clearly states:

HSAs will account for more than 10 percent of insured lives by 2010. This means that there may well be 15-25 million individual HSA accounts holding more than $75 billion in assets within five years.

xxxxxxx

It's smooth sailing now, at least in the USA.


Posted by: Ron Greiner | Aug 25, 2005 10:03:27 AM

Matt,
Being the skilled consultant that you are, I suppose you have looked at the demographics of the returning physicians vs. the exiting physicians. Could it be that the returning docs are near retirement or are retiring and that those that are leaving are the practicing physicians who want to make decent livings and work in regulated free markets, not as slaves in a government-run system?

Posted by: Donald E. L. Johnson | Aug 25, 2005 10:15:42 AM

In Canada, a man sued becuase he didn't get a hip replacement fast enough, and the courts were on his side--they said to Quebec, "having a healthcare system that makes people wait too long is illegal," although they didn't rule it unconstitutional.

But in America, what can you do if you have to wait for a hip replacement? Or if you can't get a hip replacement at all?

Personally, I think it would be comforting to know that if I didn't get the care I needed, that I could go to court about it and demand some accountability! That if people said, "no" or they said "you have to wait," I could say NO WAY!

But in America, you can't do that. Here, you have to have money first before you can demand accountability. That's so wrong.

Posted by: theorajones | Aug 25, 2005 10:25:16 AM

RE: Donald Johnson's comment...

Couldn't demographics could work the other way, too? Maybe the higher number of Canadian MDs leaving in previous years was driven by retirement age docs seeking a less brutally cold climate to enjoy their golden years. Most people would probably see the winter in Moose Jaw as more oppressive than single-payer health care.

Posted by: Carl Schurz | Aug 25, 2005 11:06:19 AM

//Here, you have to have money first before you can demand accountability. That's so wrong.//

Just want to point out that you have to have money to get the Court system to work on your behalf in America, too, so even with the option of demanding accountability, a person has to have money to count. :-(

Posted by: gadfly | Aug 25, 2005 11:07:39 AM

That's right lets go with the Hugo Chavez healthcare plan...

Posted by: Orlando Portale | Aug 25, 2005 12:52:13 PM

Uh, Orlando:

Does that mean we have him assassinated?

Posted by: jib | Aug 25, 2005 1:37:55 PM

theorajones,

I linked to Health Care For All-California's website, and I think that I shouted out to you. Ron went to the site and read up a bit. These folks are trying to get a single-payer plan passed for California. It's worth checking out.

http://www.healthcareforall.org

Posted by: Abby | Aug 25, 2005 2:35:36 PM

If anyone bothers to look at this report on the website, the physician migration is from any country, not just the U.S. So as far as we know, all of the physicians that left went to the U.S., but those returning came from Sub-Saharan Africa, Antarctica, or France. Interestingly, all the physicians are not necessarily Canadian citizens, so those leaving could be Canadian physicians, and those coming could be from anywhere else but the U.S. Granted, the most likely place is the U.S., but we don't know.

It also says that the physician workforce is older and increasingly women, two groups that are less likely to leave any democracy on their own. Plus, it's one year since 1969, with only a recent trend, and no reasons are given for why these physicians left/returned.

How anyone can draw the types of conclusion about the desirability of one system over another from these nebulous statistics is beyond me.

Posted by: Joe C. | Aug 26, 2005 2:55:43 AM

Arnold should say, "Caleeefornia Conservatives Unite, it's TIME for your Tax Free HSA."

Why? Because it's Republican.

Will he? No, he doesn't know about it yet. It's on a nead to know basis. When Governor Jeb Bush of Florida, who just signed HSAs as a new option for state employees, thinks the Terminator needs to know, he will.

That's the last thing we need is for some other Governor talking about HSAs before the 2008 election.

And if you are a banker considering to establish your tax free HSA program, before the other banks, because of that DiamondCluster press release, always remember, that DiamondCluster "forgot" to mention that some Tax Free HSAs have no annual fees and pay 6% interest, tax free. Plus, a mutual fund option, checkbooks, debit cards and everything is online for the clients who really like building wealth and lowering premiums with a little class.

But don't let that stop you. Jump on in the water is fine. Any bank that offers an IRA, isn't that all of them, is automatically qualified to offer tax free HSAs by Federal law. The last thing you want is for your bank employees getting their tax free HSA at your competitor bank, across the street, just because you are so lathargic, it's pathetic, or too lazy to start your HSA program, you losers.

If I was a banker I would wait until the bank across the street was getting Medicare HSA deposits, electronically, filling accounts of empowered seniors, from the Federal Government. I wouldn't want to be thought of as forward thinking. Besides, what if the Liberals make America's best tax dodge illegal again, which would take an "Act Of Congress". I think rookie bankers should just look before they leap.

Posted by: Ron Greiner | Aug 26, 2005 5:17:18 AM

Find out how many US physicians are migrating to Canada andyou will have your answer--I have suggested it to Marcia Angell and Arnold Relman, yet they stay.

Posted by: Terry Nugent | Aug 26, 2005 7:24:41 AM

Tax Free HSA News 08/26/05

Dan Perrin is reading Matthew's rants on HSAs. He has commented here before. Today Parren is giving advice on shopping for HSAs. Matthew was saying HSA insurers can have higher Out-Of-Pocket (OOP) expenses than allowable HSA deposits. Parren said: "Start with a properly priced health insurance plan. Look for one that provides 100 percent coverage above the deductible. That way, you won't be stuck with a gap in coverage."

That's pretty funny, we are the only ones in CA with a $2,600 HSA deductible that pays 100%. Those other CA HSA plans are from rookie local yokel insurance companies, like what Matthew has.

Then Dan likes to ramble on about a goofy hospitalization rider, for a one time fee, that disappears, it's garbage. If Dan did a little research he would discuss SuitSolutions that always pays the HSA deductible, less $100, with accidents, so HSA funds may continue to grow instead of spent. But he is spreading the good word about HSAs and retirement, so that's good.

http://www.healthscout.com/news/1/527392/main.html

This continues with: "That raises some tricky questions: Should you pay for your next doctor visit with funds set aside in the HSA? Or is it better to let the money accumulate and earn interest?

"It depends on your situation," said Dan Perrin, president of the HSA Coalition in Washington, D.C., and publisher of HSA Insider, a source for HSA information.

If you don't have to take the money out, Perrin said it would be better to keep it in your HSA until you reach the age of Medicare eligibility. He believes the government insurance program for older and disabled Americans is likely to face benefit cuts in the future. When that happens, beneficiaries are going to need more money to pay for uncovered medical expenses, he explained."

Dan Perrin should say, "If you have a chronic sickness maybe it would be better to get low deductible insurance from Blue Cross." But no, this article says sick people love HSAs too.

DiamondCluster International is in the HSA News again too. It is written: "Banks Need Open Healthcare Payment Systems
Business Intelligence Network
Aug 26 2005 : US banks chasing the USD 1 trillion in HSA income that is estimated to be up for grabs through 2008 to 2010 have been advised to initiate strategic partnerships to maximize their success. Research from The Medical Banking Network, Diamond Cluster and TowerGroup confirms that banks need interoperable HSA payment systems, payer partners, real-time pricing and expedited claims adjudication to succeed in the HSA market. With one million new HSA accounts opened in the first half of 2005, early entrants to the HSA value chain are already carving out their future success."

http://www.epaynews.com/index.cgi?survey=&ref=browse&f=view&id=1125065042622215212&block=

Boy, this is really heating up.

Posted by: Ron Greiner | Aug 26, 2005 7:50:11 AM

On the topic of HSAs as an option for state employees, and the possibility of "Medicare HSAs", I thought I'd mention some statistics for Federal employees and retirees, which already have HSAs as an option.

Of the 4 million enrollees in the FEHBP, roughly 4,000 have signed up for HSA plans. And this is from a program with generous employer contributions and a favorable plan design for even the sickest members.

A typical HSA plan in the FEHBP: A $2000 deductible, a $1000 employer contribution, and a $4000 out-of-pocket max (really just $3000 after the contribution). In theory these plans should be very attractive for those healthy members who spend less than $1000 yr on healthcare, plus any person that would incur more than $3000 in healthcare expenses.

So, why the huge popularity of the plans? People obviously want spend time thinking about the personal financial implications of their healthcare choices. They appreciate new health insurance options and are interested in taking more control over their healthcare spending. And, most importantly, everybody is extremely displeased with the status quo.

Posted by: Chris Vaughn-Uding | Aug 26, 2005 7:54:19 AM

//And, most importantly, everybody is extremely displeased with the status quo.//

Ahh, out of the frying pan into the fire, huh? I should hope the grass is greener phenomenon is not behind people's healthcare decisions.

Also, is 0.1% really "huge popularity"?

I wonder, is this part of President Bush's new marketing plan? Have government employees spread propaganda about HSAs on health policy blogs?

Also, are federal employees in non-HSAs really spending $3000 out of pocket each year? That is not a generous health insurance plan. I had two surgeries last year and a 5-day hospital stay and my OOP for the year was about $500, including premiums. That's a generous health insurance plan. If spending $3,000 OOP is considered a small amount, the poor might as well give up on healthcare.

Posted by: spike | Aug 26, 2005 8:47:11 AM

Spike,

HSA enrollments are a majority individual health insurance plans and not dangerous group health employee plans that some employer chooses for you, so far. This could change by 1/1/06.

If the Federal Government gave employees the choice of our HSA and individual insurance, we are so much cheaper and in more states than anybody else, we would have a majority or over 2 million HSAs now, just from Federal employees.

Heck, probably we would have 500,000 Federal employees just because we have a Dependent Conversion Priviledge that the Federal choices lack.

Soon the consumers will be smarter. You spike, don't even know how much your insurance costs, you are not one of those informed consumers.

Chris is right, the status quo has got to go.

Posted by: Ron Greiner | Aug 26, 2005 9:29:50 AM

I leave you guys alone for one day and you all miss the point.....

Of course we're not getting Canadian system here, nor would I reccomend it, although the Canadian system clearly works better for Canadians than the American one does for Americans--espeically if you are below average income.

Ron, aside from the HSA stuff, in the UK -- yup that bastion of socialism that I came from, where I voted for a real conservative Maggie Thatcher (not that she changed the basics of the NHS)-- you can buy private insurance to "jump the queue". But everyone is covered and no one is left out of the queue as they are here.

Secondly, search this blog, but the waiting list times from NCPA and Frasier do not match the real figures--they are nowhere close to the real figures. Those organizations are hopelessly biased, and no one ought to take them seriously -- even someone as biased as you Ron -- it doesn't help your arguments.

And for the rest of you....Of course the number of physicians going back and forth between here and Canada means NOTHING. I was poking fun at all those loony so-called free-marketers (none of whom have actually read Adam Smith or probably heard of him), who claim that Canadian doctors coming here are proof that their system is not working. If you are going to use bullshit arguments on bullshit data, you should expect to have that same bullshit tossed back at you when the data changes.

I'm still waiting for the retractions.

Posted by: Matthew Holt | Aug 26, 2005 10:20:06 AM

Matthew is right,

I'm still waiting for the NCPA to take back that family health insurance costs $4,000 a year from back in 2000 when Gore said it costs $6,000. I contacted them and pointed out that MSA family health insurance only costs $90 a month back then for a 30 year old couple and 2 children in Des Moines, Iowa. I mean really, with friends like that we needed no enemies.

But the Democrats in CA want to outlaw private insurance like in Canada. I'm glad that the Brits don't have to put up with these Democrats like are here in America, well CA.

DiamondCluster International saying there will be "One Trillion" deposited in HSAs by 2010 is a good number right? That's with a T. not a B.

My British neighbor was let back into the country, 8 days early I might add. She says that her British health insurance won't cover her here. Our coverage is World Wide Coverage so that's one difference right there. The free and open market can work pretty darn good sometimes.

U.S. Customs told my neighbor when they broke the rules and let her in, "Next time wait till it's legal before you come back."

Posted by: Ron Greiner | Aug 26, 2005 11:19:07 AM

//Democrats in CA want to outlaw private insurance like in Canada.//

Perhaps it's because the democrats noticed there were a bunch of people like me going to the ER for basic infections...and other problems picked up by the basic evils of poverty - poor nutrition, wrecked immune system, and often poor hygiene. Democrats finally realize that those people falling through the cracks will eventually pull everyone down with them.

Posted by: gadfly | Aug 26, 2005 12:50:09 PM

NewsFlash gadfy,

4 hours ago: Down Under they are talking about the USA's HSA. The NCPA has been there too.

They report: "I'm calling for a national experiment that would allow the creation under Medicare of up to 100,000 MSAs," Gross says. "Let's evaluate whether they reduce the use of beds, and improve savings. If it doesn't work, let's try something else."

That is a good way to do it is just have a little MSA experment like we did here in America with the "Original Pilot Test."

Herrick of the NCPA, a big brainer PHD guy, restricted his MSA deposits to only $1,200 a year. That was not smart. My clients, many enrolled before Herrick, were never restricted to $1,200 per year. Even the first year of 1997 the maximum deposit was $2,250 for a single and $4,500 for a family and they have been going up by CPI ever since. Then Herrick was spending the tax free MSA money. He better listen to Dan Perrin.

http://www.theaustralian.news.com.au/common/story_page/0,5744,16392947%255E23289,00.html

I'm sorry gadfly, you're Democrat plan in CA will not be passed. If it is, the Terminator will veto it.

Posted by: Ron Greiner | Aug 26, 2005 1:08:52 PM

Ron,

Strictly on the politics of this thing...

I know that HSAs are on the verge of turning America into a place where our rivers literally flow with milk and honey, but I think that you might be overestimating average Americans' eagerness to get the banking industry involved in health care.

A lot of people just want to be able to take their kids to the doctor and not feel like they're facing financial disaster if a test comes up badly. Period. They're not going to be wild about being bombarded with millions of dollars of ads offering free checking if they turn their health care dollars over to ChaseManhattan or Bank of America. (I'm already starting to hear these on the radio in my town.)

Americans could not be blamed for thinking: WTF does free checking have to do with good health care? And wouldn't the money spent on six pieces of direct mail I've gotten about HSAs this week be better spent on, well, health care?

A lot of conservatives assumed that Americans just could not wait to turn Social Security over to Wall Street. Jokes about the Democrats aside, that hasn't turned out so great for President Bush. I think you may be jumping to some similar conclusions on whether everyone thinks it's going to be just awesome when we have to call a bank's call center to deal with health care questions.

Carl

Posted by: Carl Schurz | Aug 26, 2005 1:50:14 PM

Terminator might will veto it, but the nurses are kicking Arnold's pathetic political butt around here.

Posted by: janinsanfran | Aug 26, 2005 1:51:43 PM

I suppose it's too much to expect that Mr. Greiner could just buy an ad on these pages? I'm sure Matthew would sell some nice discreet space to him. It might eliminate some of the hype in the comments.

I'm sorry. I like reading the material Matthew has here, and I like the give-and-take, but reading the one-trick-pony stuff from Mr. Greiner is causing me to wonder how good the signal-to-noise ration is anymore.

Posted by: Linkmeister | Aug 26, 2005 1:54:33 PM

Sorry gadfly,

How soon I forget, like Toby Keith says, "I'm getting some years on me now." The above post is wrong, as if anybody here would ever know. But I will correct the maximum HSA deposits of the past, silly me. The maximum MSA deposit, this is still true today, is 65% of the deductible for single coverage and 75% of the deductible for family coverage. Plus, there are no catch-up clauses, like the HSA, for additional deposits for those over 55 years old.

The HRA salepeople were using MSAs in the past just like they do today, like Newt Gingrich, the cheaters. These fruitcakes had an article in "Entrepeneur" back in 2001 that I couldn't let pass and I corrected them with a Letter to the Editor that they "Censored". This "letter" is correct because my wife approved it, unlike here. Remember that the MSA deductibles were always moving every year. Plus, for about 4 years in a row the MSA enrollments always ended on 12/01 of that year. We always ended our commercials with, "Enroll before December 1st, because Federal law ends enrollments on this tax dodge. It's like a government special on tax free money." I believe in creating urgency, especially when it's true.

// Feedback - Letter to the Editor
Entrepreneur, Nov, 2001


From Sickening to Sweet

Your article "Sickening, Isn't It?" (October "Smart Moves") needs correction. Medical Savings Accounts (MSAs) can't be combined with insurance with a $5,000 deductible. This is not an IRS-sanctioned MSA. MSA insurance must have a family deductible between $3,200 and $4,800 or a single deductible between $1,600 and $2,400. With proper insurance, MSAs may have tax-free deposits, growth and withdrawals. You must be self-employed or have fewer than 50 full-time employees to qualify.

Few insurance companies have qualifying plans, and few agents have taken the time to understand them. But many families have MSA insurance for less than $200 a month. Employees pay the premiums, and the employer makes deposits. The maximum annual deposit is 75 percent of the family deductible--$3,600. Employees can choose to have first dollar coverage on vision, dental and small medical expenses up to the deductible, or they can grow their savings. Having 20 years of deposits plus tax-free growth is better preparation for 30 years of retirement healthcare. Money that isn't taxed, simply goes further.

You must enroll before December 1, 2002. Once you open your MSA, you can keep it forever. (Employers can continue to offer new MSAs beyond the cut-off date by making deposits into employees' MSAs.) Congress will then study MSAs and what effect they have on the health-care marketplace to determine if they should be available for all.

The easiest way to accumulate wealth is in untaxed accounts. To find out more, visit Save101.com.

RON GREINER

Director of agent//

http://www.findarticles.com/p/articles/mi_m0DTI/is_11_29/ai_83663645

I ended the real letter with - President Bush supports tax free MSAs for all Americans. (They took that part off)

Sorry if I caused you any confusion.

Posted by: Ron Greiner | Aug 26, 2005 2:27:23 PM

Carl,

You wrote: //A lot of conservatives assumed that Americans just could not wait to turn Social Security over to Wall Street. Jokes about the Democrats aside, that hasn't turned out so great for President Bush. I think you may be jumping to some similar conclusions on whether everyone thinks it's going to be just awesome when we have to call a bank's call center to deal with health care questions.//

Here is the difference Carl. The Personal Savings Account (PSA) is just a dream or vision of the President. But the tax free HSA is the law of the land and can't be stopped. See the difference? It's one leg of the Ownership Society.

Posted by: Ron Greiner | Aug 26, 2005 2:36:45 PM

Ron,

I'm a little underwhelmed by your analysis.

There's a big difference between HSAs becoming legal and HSAs becoming a successful system that real people actually use, like, and accept as a good idea for health care. I think there could just as easily be a huge consumer and voter backlash against "FREE CHECKING with your first MAMMOGRAM -- CALL NOW!" health care.

There is such a thing as political overreach, especially when such a major change to how people get health care is slipped into another unpopular health care bill that had to be rushed through Congress with a lot of misleading predictions to get a bare minimum of support.

Not too long ago, I endured quite a lecture from a libertarian friend who crowed that deregulating electricity in California meant it was only a matter of time before every state "empowered consumers" likewise. But I haven't noticed many states handing their energy infrastructures over to corporations lately.

A few years ago, pharma told us that if we just let them market drugs directly to consumers we would unleash choice and competition and go a long ways towards fixing our health care problems. But that didn't happen either. Drugs don't cost less. Most of the new competition that was unleashed was over marketing budgets and clever branding names for new drugs, not actual innovation.

Carl


Posted by: Carl Schurz | Aug 26, 2005 3:20:32 PM

Carl,

I keep it simple with advertising. Something like;

Don't pay $1,000 a month for health insurance. Many families have HSA health insurance for $200 a month, then they grow their savings in a tax free HSA.

Presedent Bush says, "Become empowered with a tax free HSA."

Call toll free Blah blah blah

Then they call me paying $1,300 a month for COBRA insurance, because they just got fired and they need 2 months premiums to continue, and I tell them they can get HSA coverage for $211 a month and they are so pleased. Then I tell them the HSA is free, there are no fees, and we pay 6% interest or they may place the money in mutual funds if they choose.

People like you Carl don't call, thank goodness.

But rdg, who comments here, got HSA coverage for $160 a month and his COBRA was $800. It's just an option Carl that some people want. And of course the HSA is designed for tax free deposits, growth and withdrawals. I think you will agree Carl that the best tax cut is NO taxes. Of course money that is never taxed will last longer in retirement.

HSAs and going tax free is not for everyone Carl.

Posted by: Ron Greiner | Aug 26, 2005 3:56:47 PM

Ron,

I wonder if we can read anything into your observation that people "like me" don't take President Bush's advice and call you up to order a HSA.

I never call to order the gold investment guides, baldness cures, and clincally proven sexual dysfunction treatments that are advertised on Rush Limbaugh's show, either.

I suspect there may be a correlation.

Carl

Posted by: Carl Schurz | Aug 26, 2005 4:38:40 PM

//WTF does free checking have to do with good health care?//

That comment wins!

Posted by: gadfly | Aug 26, 2005 4:50:04 PM

OK kids--remember this one was about Canada NOT HSAs...

this one's closed! Ask me if you want an open thread or if you want to buy an advertisement (as Linkmeister Steve suggested to Ron).

Posted by: Matthew Holt | Aug 26, 2005 5:45:39 PM

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