scott wrote:
> 
> Yeh, if you are in the public system here in Germany (well in Bavaria at 
> least), you need to get referred from your normal doctor before you go 
> to see a specialist.  Or you can just pay 10 euro ;-)  It's the same in 
> the UK I think, you can't just make an appointment with a specialist, 
> your normal doctor must do it for you.
> 

Another health insurance option in the US is HMO (Health Maintenance 
Organization) - which is similar to what you describe.
Typically you have a primary care physician that directs your care.  You 
have to get prior approval before you can go/do anything else.
HMO's here have a bad reputation because of some things that have gone 
on in the system.  Doctors are pressured and even rewarded for referring 
less patients to expensive specialists (hmmm... is that in the best 
interest of the patient.)  I've heard horror stories about care that is 
denied and denied and finally in the end when it is approved it is too late.

But the HMO scenario is different from what you described in that in the 
US it is all capitalistic driven - profit is put ahead of people's lives 
and wellness.


OTOH
The PPO and Traditional plans, you can make an appointment with a 
specialist on your own without a referral.  It's just certain procedures 
that require a prescription from a doctor - kinda like a prescription 
for narcotic medicine.




>> It has its problems, yes.  And some people leave the US to go to other 
>> countries to get different care.  Just as some people come to the US 
>> to get different care.
> 
> I don't think it's the level of care that is the problem, just the cost 
> of the system.
> 

I agree, the level of care isn't the problem.  I think it does vary from 
location to location (even in the same country), but it isn't the issue 
with this.

I think it is also the available of choices that drive people to 
different countries.  I know that people will go to Mexico from the US 
to get certain treatments that are either hard to get or illegal in the US.


> 
> Yeh, well it's the same in the UK for the public system, they have a 
> finite amount of money from taxes so they can't go around fixing 
> everything the expensive way.  If they cured everyone with eye cancer 
> rather than removing the eye, they probably wouldn't have enough money 
> to save some other peoples lives.  But, you can always go to a private 
> doctor yourself and pay for whatever treatment you want, isn't that 
> possible in Canada?
> 

My understanding is that while you can do it, it can take a long time 
and may be complex to do it.  hence go to a country where it is readily 
available and quicker.


To bring this back closer to topic....

 From an financial point of view, if I were in an accident, I would 
prefer to be in a different country than the US.  In the US I would have 
to deal with insurance companies for the property damage.  I would have 
to deal with insurance companies for the medial costs.  Sometimes there 
are hidden medical problems that surface years later that you now have 
to pay for because the insurance stuff is all done.

 From a very narrow point of view...
So, in the US system, it is better to ban studded tires and save the 
road.  The government saves the tax dime while the people pay the 
private medical care as a result of the accident.

In Finland, or many other countries where there is medicine paid by 
taxes, the government saves the tax dime by allowing studded tires 
because it saves on the medical expenses that is also covered by tax.

Anyhow.... enjoy whatever snow is left in the season.

Tom

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