When I went to grad school in the US, I got insurance through my regional government. It was rejected by the school (so, I had to get a local policy) because the policy hadn’t been written in US terms: it covered (either through preapproval and direct billing to the insurance company, or via reinbursement) “anything which would be covered by the UHC system in Spain”. To me that was absolutely clear; to the Americans, clear as mud.
Currently, both my travel insurance and my third-party civil liability insurance cover me anywhere except the US.
I suspect this as well. But we’d need to train more medical personnel, then, because American doctors are certainly not underworked, and I don’t think there are plans to open up any new medical schools any time soon. I think that we will need to increase the amount of medical training when we expand medical care.
If our current doctors could actually spend time treating patients rather than wrangling with insurance companies, we might find we *do *have enough. The career would also be more enticing to young people considering it, and fewer would want to leave it.
I think this would be an expenditure that we could all get behind. Let’s make sure we’re not losing any otherwise qualified health care professionals because of scarcity of training facilities or personal affordability.
Yes to this. Income is only part of the equation. Job satisfaction is important, too, and it can hardly be satisfying making medical decisions in coordination with insurance companies.
Well. While the US has fewer doctors per head of population generally than other first world nations, its got an even more severe shortage of general practitioners. That is normally considered to be because being a specialist is much more lucrative.
I believe that unlike in Europe, GP is not a specialty in the US. (This probably pulls the US stats on results down a bit, I expect)
This comes up now and then in discussions about waits, because they are not uniform across a system. The US does poorly on waits for GPs, but above average for access to specialists.
Anyway, my very local paper ran a human interest story this weekend. It was about a family whose daughter, at the age of 13 was diagnosed with something like a weak blood vessel in the brain. (Unclippable uncoilable MCA) In a very difficult location. She was put on a “watchful waiting” program. About 2 years ago, when she was 17, there were signs that it was weakening further and might rupture soon. It seems to be a very rare thing, and required specialization not available locally. The family went to New York, to a Dr. Amir Dehdashti.
Among the things that were explained to them at the hospital was that a downpayment of 35 000 $ was expected before they even got to see the doctor.
The operation was successful, otherwise I guess it wouldn’t have made a good human interest story. During the days in New York the family mentions passing an ambulance trying to tend to someone who’d been involved in an accident. The bleeding man did not want to go in the ambulance because he could not afford it. It did make them reflect on how they’d gotten shipped across the world to best specialists, all covered by the Norwegian health care system, while the Americans in the same city could not afford an ambulance.
Which makes me think: If you really need it, the odds of seeing the best specialists in the US are probably better for the average Norwegian than for Joe Average American. Maybe way batter. So the current US system is working quite well for us. Not so much for the nation whose people may have to refuse ambulances when injured, because they can’t afford them
All the discussions seem to miss to me what is the more natural fit to the US due to some of the common factors from the origin - the French model which is a private hybrid.
The idea of the state mandated Mutual Insurance companies - i.e. mutually owned health insurances owned by the policy holders (at least in their origin private although it can be confessed the French state is interventionist - but it is so in all subjects) would be ideologically compatible with the US and would also have the same purpose of the transition from the pure Employer basis (which the French system had in many parts until the reforms).
Looking to the more purely state models does not seem to me realistic for the US given your ideological blinders in the mass.
(even though as a market liberal it seems to me like a substantial gain in the efficiency for a market system [health care] that is by any rational analysis very subject to a lot of time-and-money opacity in the decisions and a lot of “perverse incentives” that make a market operation on the naive Econ 101 concept non-working, at least at the Pareto optimal).
Whatever you choose, you would still need some trusted, authoritative, transparent and clinician-led evidence base for costing (and cost-effectiveness) of different treatments and services.
That’s a good point, Ramira. The debate in the US seems to assume that the only way to achieve UHC is by single-payer, which in turn is an ideological problem. The French, German or Australian models, with heavily regulated private insurance companies, may provide a better fit to the American political system.
It’s not impossible that changing the financial set-up would create new incentives or disincentives to treat differently. If you’re spending more than other countries, where might you be getting better or worse value for money than they do? How much might that value for money be improved (or not) by encouraging the use of GPs as gatekeepers/filters, delegating more tasks to nurse practitioners and pharmacists, using “watch and wait” more, not using screening or expensive diagnostic tests unless the risk factors are at y% rather than x% - and maintaining a clinical agency that can consolidate the evidence base and provide the relevant cost-effectiveness guidance?
It depends on which European model you use: If you chose the Bismarck model (German type UHC) you’ll likely see the various employment-based insurance schemes subsidized and expanded so people without employment can and must get on them. Sort of like an expanded Obamacare where you get to go on the employment insurance deal of your choice rather than the exchanges. Varieties include for profit insurance or compulsory non-profit.
If you go with the Beveridge model, like the UK, Iberia and the Nordics use, it’ll be like an expanded VA system where everyone is eligible. You’ll probably see the number and staff of the clinics expand. Veteran healthcare benefits for all. Varieties include a federal system or more regionally based one, probably a stated-based one where each state introduce their own mods. Could be less market, oriented like the US or use more markets like Norway.
If you go with the National Insurance model like Canada, it’ll be more like Medicare for all. Basically taking the age limit off Medicare. Varieties would be more like how much of a co-pay you got. I think its 20 % of costs now? Canada has 0 co-pay, and other options include capping co-pays at a certain amount.
Or you could end up with a hybrid system cobbling together several of these, in which case all bets are off. For example, you could see free catastrophic healthcare for all, and free healthcare for everyone under 18 but expensive plans beyond that. Or…anything really. France has a hybrid system.