[Oe List ...] Healthcare: U.S. and other industrialized nations

[Janice Ulangca]

I've heard T.R. Reid interviewed on NPR - impressive and timely.  So was glad a colleague sent this summary.  I did the bolding to mark the different myths.  Janice Ulangca  (And myths can be such good things!  meaning-bearing stories!)



Tue, Aug 25, 2009

Opinion

How other nations beat the US on health care

By T.R. Reid  

/T.R. Reid, a former Washington Post reporter, is the author of "The

Healing of America: A Global Quest for Better, Cheaper, and Fairer

Health Care." /

/Special to The Washington Post /

Tucson, Arizona | Published: 08.25.2009



As Americans search for the cure to what ails our health-care system,

we've overlooked an invaluable source of ideas and solutions:   the rest

of the world.

All the other industrialized democracies have faced problems like ours,

yet they've found ways to cover everybody - and still spend far less

than we do.

I've traveled the world from Oslo to Osaka to see how other developed

democracies provide health care. Instead of dismissing these models as

"socialist," we could adapt their solutions to fix our problems. To do

that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do

provide health care in government hospitals, with the government paying

the bills. Others - for instance, Canada and Taiwan - rely on

private-sector providers, paid for by government-run insurance. But many

wealthy countries - including Germany, the Netherlands, Japan and

Switzerland - provide universal coverage using private doctors, private

hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the

United States. Almost all Americans sign up for government insurance

(Medicare) at age 65. In Germany, Switzerland and the Netherlands,

seniors stick with private insurance plans for life. Meanwhile, the U.S.

Department of Veterans Affairs is one of the planet's purest examples of

government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private

health insurance plans - a broader choice than any American has. If a

German doesn't like her insurance company, she can switch to another,

with no increase in premium. The Swiss, too, can choose any insurance

plan in the country.

In France and Japan, you don't get a choice of insurance provider; you

have to use the one designated for your company or your industry. But

patients can go to any doctor, any hospital, any traditional healer.

There are no U.S.-style limits such as "in-network" lists of doctors or

"pre-authorization" for surgery. You pick any doctor, you get treatment

- and insurance has to pay. Canadians have their choice of providers.

As for those notorious waiting lists, some countries are indeed plagued

by them. Canada makes patients wait weeks or months for nonemergency

care, as a way to keep costs down. But studies by the Commonwealth Fund

and others report that many nations - Germany, Britain, Austria -

outperform the United States on measures such as waiting times for

appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to

make an appointment.

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free

enterprise - private-sector, for-profit health insurance - is naturally

the most cost-effective way to pay for health care. But in fact, all the

other payment systems are more efficient.

U.S. health insurance companies have the highest administrative costs in

the world; they spend roughly 20 cents of every dollar for nonmedical

costs, such as paperwork, reviewing claims and marketing.

France's health insurance industry, in contrast, covers everybody and

spends about 4 percent on administration. Canada's universal insurance

system, run by government bureaucrats, spends 6 percent on

administration. In Taiwan, a leaner version of the Canadian model has

administrative costs of 1.5 percent; one year, this figure ballooned to

2 percent, and the opposition parties savaged the government for wasting

money.

The world champion at controlling medical costs is Japan, even though

its aging population is a profligate consumer of medical care. On

average, the Japanese go to the doctor 15 times a year, three times the

U.S. rate.

They have twice as many MRI scans and X-rays. Quality is high; life

expectancy and recovery rates for major diseases are better than in the

United States. And yet Japan spends about $3,400 per person annually on

health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but

so are other countries with much lower cost structures. Any American

who's had a hip or knee replacement is standing on French innovation.

Deep-brain stimulation to treat depression is a Canadian breakthrough.

Many of the wonder drugs promoted endlessly on American television,

including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United


States, an MRI scan of the neck region costs about $1,500. In Japan, the

identical scan costs $98. Under the pressure of cost controls, Japanese

researchers found ways to perform the same diagnostic technique for

one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject

applicants with a "preexisting condition" - precisely the people most

likely to need the insurers' service. They employ armies of adjusters to

deny claims.

If a customer is hit by a truck and faces big medical bills, the

insurer's "rescission department" digs through the records looking for

grounds to cancel the policy. The companies say they have to do this

stuff to survive.

Foreign health-insurance companies, in contrast, must accept all

applicants, and they can't cancel as long as you pay your premiums. The

plans are required to pay any claim submitted by a doctor or hospital,

usually within tight time limits. The corollary is that everyone is

mandated to buy insurance, to give the plans an adequate pool of

rate-payers.

The key difference is that foreign health-insurance plans exist only to

pay people's medical bills, not to make a profit. The United States is

the only developed country that lets insurance companies profit from

basic health coverage.

*U.S. system has elements of all *

In many ways, foreign health-care models are not really "foreign" to

America, because our crazy-quilt health-care system uses elements of all

of them.

For Native Americans or veterans, we're Britain: The government provides

health care, funding it through general taxes, and patients get no

bills. For people who get insurance through their jobs, we're Germany:

Premiums are split between workers and employers, and private insurance

plans pay private doctors and hospitals. For people over 65, we're

Canada: Everyone pays premiums for an insurance plan run by the

government, and the public plan pays private doctors and hospitals

according to a set fee schedule. And for the tens of millions without

insurance coverage, we're Burundi or Burma: In the world's poor nations,

sick people pay out of pocket for medical care; those who can't pay stay

sick or die.

This fragmentation is another reason that we spend more than anybody

else and still leave millions without coverage. All the other developed

countries have settled on one model; we've blended them all into a

costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America

has "the finest health care" in the world. We don't.

In terms of results, almost all advanced countries have better national

health statistics than the United States does. In terms of finance, we

force 700,000 Americans into bankruptcy each year because of medical

bills. In France, the number of medical bankruptcies is zero. Britain:

zero. Japan: zero. Germany: zero.

Given our remarkable medical assets - the best-educated doctors and

nurses, the most advanced hospitals, world-class research - the United

States could be, and should be, the best in the world. To get there,

though, we have to be willing to learn some lessons about health-care

administration from the other industrialized democracies.


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