5 Myths About Health Care Around the World
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.
Koba's Note: Hmm, quite fascinating... And here's the source for Slothen, before he asks...
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778_pf.html
September 1st, 2009 - 13:10
1.
This article seems to flatly ignore the fact that whether you socialize the institution or socialize it’s feeding tube, the net effect is the same. It then goes on to claim some large difference between socializing outright and regulating to the point that the only difference between plans is to what degree the cover beyond the government mandated minimums. That is to say that, poor people still get minimum coverage and rich people still cut in line and nobody has the choice to cut back on pointless coverage to save money.
2.
I’ve already noted that when plans are standardized by a government, the only choice in two hundred or even two thousand, the only option is what you want to add but never subtract. As for the waiting lines on elective care, I can only point out that the only elective for diagnosis is whether you elect to go to the U.S. and get your cancer or other silent threat diagnosed before your home system lets you die in line. As to the likelihood of a ‘commonwealth’ survey of wait times being even remotely accurate when they base it on our booming cosmetic and eye repair(the implied use of elective in this part of the article) as compared to the somewhat dangerous practitioners of those same procedures in other countries. It’s no surprise that when comparing care, the author uses longer waiting lines for our electives(cosmetics) and shorter in theirs, while using their electives(mri, catscans) as a demonstration of long lines in socialized nations. By fudging the lines between what is elective and what is a necessary diagnostic tool, she does make a seemingly good show of making our system look bad in comparison. That is not to say that our system is particularly good. The legislative sector of medical care needs some serious pruning before those overgrown limbs tear the entire system away from it’s roots.
3.
This is a fascinating way of looking at expenditure. Administrative costs do have an impact on how much a given country spends on healthcare. It tends to be a minor one, well excluding Britain which employs more administrators than doctors and is the worlds 3rd largest employer(behind the Chinese army and the Indian railroads), but she is right in thinking we too spend far too much on telling people with medical degrees how to use them when we(government cronies) know next to nothing about the intricacies of medical care. Lets look at some of the other ways socialized states control costs. They like to cap pay rates. That’s why so many doctors in America have such difficult to pronounce names. We sort of have an opposite problem here. The AMA has been doing it’s best to limit the number of doctors in the U.S. and increase the number of procedures that unrealistically require a doctor’s presence. This has created a scarcity of doctors which drives up costs. This is the same organization that Obama is buddying up to and wants to give even more power over who can treat you for what. As for the wonder of Japanese cost cutting, I’m afraid it has very little to do with policy and very much to do with social norms that would not be acceptable in this country. Costs are greatly reduced when the stigma of failure, the loss of perceived face, and the thought of being a drain on resources are only treated by one very cheap procedure. I call it self-rationing. You call it suicide.
4.
The last sentence of the first paragraph needs only the addition of “funded by American neuroses”. I can only wonder what will happen to foreign innovation when their biggest buyer switches to a socialized system that can no longer afford anti-depressants, penis pills, and costly joint replacements for folks who will be dying soon anyway. As for other countries having innovation, yes they do have innovations, just not as many as the U.S. or at nearly the same rate. As for the innovation of Japanese MRI’s, there is none. The government controls prices, the cost still exists, it just gets moved another part of the budget, namely the care of people who already lobbed themselves off of a bridge(humorized dramatization, I have no idea what procedure now costs 1402$ more or which 1402 procedures now cost 1$ more). I love how moving expenditures from one column to another is enough to cut costs for democrats.
5.
I’m not nice enough to talk about this one. I like being cruel to people who act irresponsibly. The nice folks at reason.com are another story altogether. In fact, I’d suggest checking in on them before making any unwise decisions you might come to regret later.