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Old 08-25-2009, 07:11 PM
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5 myths about other countries' health care

Thanks cmac for providing a link to this in another thread. I feel this is so important that it warrants a separate thread. This article was written by the same guy who contributed to the Sick Around the World Frontline documentary about other countries' health care systems that I saw in the last couple years and found very educational (more than anything in the commercial media or on this forum). The online documentary can be seen here:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

And the article here:
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

Quote:
5 Myths About Health Care Around the World

By T.R. Reid
Sunday, August 23, 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. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

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. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

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 than ours.

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, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

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 (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. 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.

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 for health-care delivery and finance; 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.

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," to be published Monday.
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Old 08-25-2009, 08:55 PM
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Originally Posted by DieselAddict View Post
Thanks cmac for providing a link to this in another thread. I feel this is so important that it warrants a separate thread. This article was written by the same guy who contributed to the Sick Around the World Frontline documentary about other countries' health care systems that I saw in the last couple years and found very educational (more than anything in the commercial media or on this forum). The online documentary can be seen here:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

And the article here:
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

ask the doctors in those countries how they feel about it, and the future of those doctors. the report I saw was that in Germany for instance, the doctors make little more than an engineer, yet have 2X the education. they have gone on strike many. many times for higher wages and many are moving out of Germany. Frances healthcare system is only a few years away from total financial collapse. It would be nice if someone would do a non partisan appraisal rather than one that supports their agenda
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Old 08-25-2009, 08:59 PM
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ask the doctors in those countries how they feel about it, and the future of those doctors. the report I saw was that in Germany for instance, the doctors make little more than an engineer, yet have 2X the education. they have gone on strike many. many times for higher wages and many are moving out of Germany. Frances healthcare system is only a few years away from total financial collapse. It would be nice if someone would do a non partisan appraisal rather than one that supports their agenda
They did. Watch the documentary. It does cover the financial issues facing those countries' health care. That's really their only problem. Hospitals are frequently cash-strapped over there whereas here in the US it's the patients who are cash-strapped and the US is the only developed country where citizens go bankrupt because of medical bills.
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Old 08-25-2009, 09:18 PM
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This viewpoint should open a few eyes. Basically if you can eliminate the built in usage or profit motive.Your overall system should improve over time. It has always been immoral for third parties to profit from sick people. Yet thats pretty well exactly what is going on.

Otherwise greed may come to almost totally dominate at the average patients cost. Think about it. You pay insurance premiums to a private enterprise that struggles to deny you care when required if possible. Without telling you up front that it is their practice to do so. Sounds like fraud to me. Legally they can pull it off yet that does not change the reality.

As for quality of care it might even improve over time. Under our system in Canada everyone seems to recieve about equal medical service. There was an initial period of adjustment I admit freely. Now the population would not consider undoing the present system I believe. You can eventually almost go broke trying to sustain what exists in the United States now.

If the cost of drugs becomes too punative that is also taken care of here depending on your income and other factors one way or another. Next to be tackled is your bloated prescription drug industry. The prices you pay almost seem insane.

I never brought into the argument all this profit is required for research. I am well aware research costs money. No research can cost that much. What are we talking here hundreds of billions of dollars a year? Perhaps over time a form of brainwashing has evolved.

You have to get rid of the third parties before they become so powerful you cannot do it. I hope that senario already does not exist. The private health care provider companies can and will try to ensure their survival at any cost. It is too good for them presently to do otherwise in my opinion.

Politically they control much already. If they control enough is yet to be seen. If it turns out they do you cannot get rid of them in my opinion. So all the current discussions would be just academic in nature.

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Old 08-25-2009, 09:19 PM
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Thanks for posting that.
I'm curious as to how that $7000 per yr average for US healthcare costs is calculated. I spend $13200 per yr in health insurance premiums alone. That doesn't include any visits to the doctor or hospital, nor does it include prescriptions. Now that's for 2 adults and 1 child. But the cost would be the same for 2 adults. The costs for sick people have to be substantially higher. It costs me $25 to visit a doctor, $50 for urgent care, $200 for the ER and $700 for the hospital. Those numbers can add up fast.
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Old 08-25-2009, 09:21 PM
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They did. Watch the documentary. It does cover the financial issues facing those countries' health care. That's really their only problem. Hospitals are frequently cash-strapped over there whereas here in the US it's the patients who are cash-strapped and the US is the only developed country where citizens go bankrupt because of medical bills.

but if the doctors quit, does it matter. there is no perfect system, but at least the system we have rewards doctors for hard work and doesnt marginalize their efforts by mandating a pay ceiling far below what should be commanded by their education.

what I truly would like to see is a simplification of the current system's paperwork. I saw a report where a doctor had 100 patients and had to have a staff of 8 to maintain the insurance paperwork. thats just rediculous. her take home was on the order of 70-80K by the time she paid staff, and then insurance for malpractice takes a big chunk of that. to be honest I think the US is driving our best and brightest into the practice of law rather than medicine
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Old 08-25-2009, 09:29 PM
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Old 08-25-2009, 09:33 PM
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Thanks for posting that.
I'm curious as to how that $7000 per yr average for US healthcare costs is calculated. I spend $13200 per yr in health insurance premiums alone.
Ask Kirk Vining--he's got the number at $5200 in another thread.

According to the K-1, I pay $7440/year in premiums for a family of 5 for 'blue chip' coverage with a low deductible and an almost always waived copay. I paid about $500 more a month when I carried it on my own business vs. my wife's large member firm group policy for the same coverage.
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Old 08-26-2009, 01:25 AM
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This viewpoint should open a few eyes. Basically if you can eliminate the built in usage or profit motive.Your overall system should improve over time. It has always been immoral for third parties to profit from sick people. Yet that's pretty well exactly what is going on.
The arrangement between health care insurers and doctors reminds me of pimps and hookers: the hookers do all the work and the pimps get most of the money. The analogy is not too good all in all except as it pertains to the insurance industry.

Very few doctors get anywhere near as rich as most health insurance CEOs and their lieutenants.
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Old 08-26-2009, 01:42 AM
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but if the doctors quit, does it matter. there is no perfect system, but at least the system we have rewards doctors for hard work and doesnt marginalize their efforts by mandating a pay ceiling far below what should be commanded by their education.

what I truly would like to see is a simplification of the current system's paperwork. I saw a report where a doctor had 100 patients and had to have a staff of 8 to maintain the insurance paperwork. thats just rediculous. her take home was on the order of 70-80K by the time she paid staff, and then insurance for malpractice takes a big chunk of that. to be honest I think the US is driving our best and brightest into the practice of law rather than medicine
You're right that no system is perfect. But do we really need a system to be perfect before we consider using it or even just the better parts of it? You seem to defeat your own argument that in our system doctors are rewarded for hard work as you mention the high insurance paperwork & liability costs. Don't forget also the extremely high cost of medical school in the US. Doctors in other countries don't need to get paid as much as they don't face these other costs to the same extent. Perhaps the biggest difference is that in the US most doctors are compensated based on the number of services performed, not on the quality of health care administered. In contrast in Britain for example doctors are on a salary and receive a bonus if their patients do exceptionally well. This provides the right incentives and helps reduce the number of useless but profitable procedures and pills prescribed.
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Old 08-26-2009, 01:44 AM
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Thanks for posting that.
I'm curious as to how that $7000 per yr average for US healthcare costs is calculated. I spend $13200 per yr in health insurance premiums alone. That doesn't include any visits to the doctor or hospital, nor does it include prescriptions. Now that's for 2 adults and 1 child. But the cost would be the same for 2 adults. The costs for sick people have to be substantially higher. It costs me $25 to visit a doctor, $50 for urgent care, $200 for the ER and $700 for the hospital. Those numbers can add up fast.
Sounds like your insurance costs are pretty close to the average.
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Old 08-26-2009, 07:53 AM
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That's great- I guess Maine ought to try those systems then, and everybody in Obama's camp ought to study that first.
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Old 08-26-2009, 07:59 AM
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You're right that no system is perfect. But do we really need a system to be perfect before we consider using it or even just the better parts of it? You seem to defeat your own argument that in our system doctors are rewarded for hard work as you mention the high insurance paperwork & liability costs. Don't forget also the extremely high cost of medical school in the US. Doctors in other countries don't need to get paid as much as they don't face these other costs to the same extent. Perhaps the biggest difference is that in the US most doctors are compensated based on the number of services performed, not on the quality of health care administered. In contrast in Britain for example doctors are on a salary and receive a bonus if their patients do exceptionally well. This provides the right incentives and helps reduce the number of useless but profitable procedures and pills prescribed.

it is an arguement against my point of compensation, but it is only for general practitioners. Hospitals and collectives share the resources so if they partner up they can still make very good money here, and they are not capped.. My point was that all of them have this huge overhead cost in terms of insurance paperwork. if they could simplify that it would help bring down the average costs of care. when my wife came from Mexico she had no insurance here every doctor we visited cut the price 30% for a cash deal. this says to me the true costs of dealing with insurance, Im guessing 30% just scratches the surface.
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Old 08-26-2009, 08:32 AM
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ask the doctors in those countries how they feel about it, and the future of those doctors. the report I saw was that in Germany for instance, the doctors make little more than an engineer, yet have 2X the education. they have gone on strike many. many times for higher wages and many are moving out of Germany. Frances healthcare system is only a few years away from total financial collapse. It would be nice if someone would do a non partisan appraisal rather than one that supports their agenda
I'll thrown in my $0.02...

Wife is a physician, now practicing in Ontario. The waiting time aspect of Canadian healthcare has been exaggerrated by the media. You'd think people were lying on the street, gasping for breath as they await a vital organ transplant. There are waits for non-essential services, but the issue is already being addressed, and with costs of medical equipment, technicians, operating costs, etc. increasing, there will be waits for non-essential services. A small price to pay for getting top-tier care when you need it most.

Another aspect that has not been mentioned AFAIK is that being a doctor in Canada is one of, if not the, most secure high-paid job you can have.

This is a significant factor that is often underlooked, IMO.

You will be essentially guaranteed a life-long job, with a secure salary. This greatly facilitates long term estate planning and retirement. It also means that towards the latter half of a physician's career the money starts to add up fast. At the start there are mortgages, cars and medical school bills, yes, and you hear all about that in the media. Reality is that they get paid off relatively quickly with some diligence.

We recently met with our financial advisor (offered 'free' of charge through the CMA, of which doctors are members and pay dues) and she was telling us how many doctors, as early as their mid/late 40s, are socking away $10,000+ a month. They've paid off their main debts at that point and they put the money into their corporation (many doctors are incorporated). So with some wise money management, many doctors will retire as multi-millionaires. Is there really much to complain about? Not IMHO.
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Old 08-26-2009, 08:46 AM
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I would like a plan similar to the one in Germany where they would allow competition between companies on a NATIONAL scale. The current half @ssed system we have stops companies from crossing state lines. If you could choose between 200 national companies that would be great.

I also like the idea of putting everybody into a single pool or group for each company. If we spread the risks out among say 1.5 million people who use BC/BS of NY instead of the 34 employees in your company the costs SHOULD go down.

As far as a public option, take the Medicare/Medicaid people and let them choose a new company while keeping their premiums the same.

For people without insurance, have a low cost option available. Again, if the risk is spread over millions of paying customers, the cost per policy should be very small.

If you do not WANT insurance, then you do not have to to have it, however, you WILL be on the hook for any bills you accrue. No more passing the cost along to the taxpayers.
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