What lessons do we need to take from other countries in nationalizing US health care?

Great Debates
1

Given the ever rising cost of health care in the US I just can’t see health care costs keep on the same track. It just seems economically and socially unsustainable going to much farther into the future. The flip side seems to be that in the examples we see of industrialized nations with nationalized health care it takes a damn big chunk of taxes to deliver these services. As the US ages it seems inevitable to me that we will have to make the transition to some form of nationalized health care.

If this does happen what can we learn from the experiences of other countries in constructing a health care system that works?

2

First lesson: Don’t nationalize health care.

The U.S.'s biggest health care problem is a small percentage of the population (the working poor) who don’t have health insurance. Focus on that.

3

I’d start by creating a baseline to work from. Study our current system and determine what shortcomings we have, as well as what positives we have. Determine how much of our current expenditures cover the actual visits and procedures, and how much goes to the insurance companies. I’d do actual studies, not just solicit opinions.

I’d then look at countries who do better in areas we come up short, as well as countries that do well in the areas we do well in. If there are countries which appear to do pretty well in both categories, I’d use them as guidelines when coming up with a model. I’d get the input of lots and lots of doctors, nurses, and other health-care practitioners.

I’d definitely try to eliminate the need for insurance companies as middlemen, but I’d be hesitant to outlaw private insurance as an option for those who choose to use it, even though I understand the arguments that support outlawing the practice. I think you can resolve most of those arguments with well-crafted legislation (yes, I know…).

4

An excellent point, but voters won’t spend their money to help others; they will vote for something that makes their health care cost less and only incidentally helps the poor.

5

As a US citizen with top notch insurance coverage who has also had to avail myself of free health care services in Australia, New Zealand, France, England and Saudi Arabia, I would assert that our biggest problem is that the health care services we deliver in the US are an embarrassment by comparison.

My vote for lesson #1: Health care is not commerce.

6

Sunacres As someone whose only ever dealt with the UK health service I’d be interested in hearing your personal comparisons on the services you received in each country.

We talk a lot about money and economics when discussing nationalised healthcare but talking about people’s perceptions can be important as well.

Did you feel there were clear differences in your treatment in each case?

7

Seconded. As someone who grew up in England and saw family suffer under NHS standards of care and slow treatment times, and who has suffered similarly myself, I fear each time I hear people talk about nationalising the US health care system.

8

The problem with our healthcare system is that local hospitals are so large, that it would be politically unnacceptale for one to go out of business.

This means that you end up with loads of bloat, lots of staff who are not good value for money, and this can range from those at the top, to those at the bottom.

I have seen secretaries, whose secretaries have their own secretaries - no I am not kidding either.

I see disgraceful attendance records, from the senior managers down to - well lets say that if you have managers with one third loss of attendance, its hardly leading the battle from the front is it?

I have seen a maintenance system that had 22 acual workers, and almost 70 hangers on from secerataries, managers, assistant managers, contract managers and plenty more - this is just one department where once there were around 30 workers, and only half a dozen managers.

NHS is horribly overmanned in some places and hopelessly undermanned in others.

There really needs to be a good hard kick of commercial discipline in the UK health service, if there were, I’d still be there and I would be paid for the work I did, not for the number of hours spent meeting the specified times on work tickets - which ae hugely inflated.

If the NHS was run with commercial discipline, then it would be far cheaper, or would serve much better, but there’s the rub, this issue of a lack of market forces is almost a philosophical one.

There is no reason why our NHS could not be run as a business, it just isn’t and the whole orgainsation suffers as a result.

The last time there was an attempt to bring in an ‘internal market’ to this industry, where no-one can ever go bust, it ended up costing bi££ions more with a huge layer of upper and middle managers recruited for no effective purpose other than to consume yet more of the budget.

9

National healthcare will likely pass. The boomers are getting older, and when have we not accommodated such a large voting block?

I’m not saying UHC is a bad idea. I’m just saying it looks fated.

10

The boomers will get full health care under medicare. Which, by the way, is a fiscal disaster in the making which will dwarf the problem with Social Security. Wait until all those demanding boomers hit the age where their health care is free. The prescription drug benefit is just the first in a long line of new health entitlements they will demand.

So yes, the U.S. health care system is going to be more and more dominated by the state, even if nothing structural changes, just because more and more people are moving into the state-financed portion of it.

First reform needed: Means testing of Medicare. Making health care a universal entitlement for seniors is insane - especially because it will require heavy taxes on poorer, younger people to maintain it. If you’re eldery and rich, there’s no reason you should get free prescription drugs or unlimited health care.

11

One major difference between systems that I see is the attitude towards who gets scarce health care. I don’t think Americans would happily accept the scarcity of services that goes along with nationalization. AFAIK, in the UK and other nationalized health systems, certain conditions are simply not treated. If you’re 80 and have cancer, then chances are the hospital isn’t going to treat it at all (which might make those boomers unhappy in a few years). Babies born very prematurely are not given the expensive, difficult and chancy treatments that might keep them alive.

If I’m incorrect, I hope some knowledgeable Brits or Scandinavians will correct me, but AFAIK the efforts Americans expect as normal are not indulged in under other systems.

I also simply can’t see how nationalized health care can work in a country so huge as the US. In a small population such as Denmark or the UK, it’s at least doable, but here–the bureaucracy would be gigantic. Everything our government touches becomes less efficient and more expensive and difficult–why would health care be any different?

12

I would not say the US is absolutely massive, just add up the Euro nations who have State Funded Healthcare and compare the populations, and you will not be far out, and that is across entire nations, differant languages and all.

Its not the size of the population that is all that important, if anything a large population would bring economies of scale.

The issue for the US is that you do not have anything like universal coverage, and yet as a percentage of GDP is actually costs more than here in the UK.

The issue really is at what stage is the healthcare system funded, for the UK it is free at point of use, but then it costs through taxation, for the US, its a mixture depending upon a number of factors.

The one benefit we do have over here, is that folk do not tend to go bankrupt due to healthcare costs, however its also true that insured US citizens can expect to be treated for conditions that are, well for want of a better word, rationed.

We in the UK can buy medical insurance, just as the US, but only a few are motivated to do that, because they have to pay direct from their own pocket, and few companies offer medical insurance as part of their employment terms.

I think that perhaps there is the possibility of state insured medical care with private providers as a model the US might consider.

You choose who your provider will be and change if you do not like the service, and the funding moves around with the patient.
Individuals could then supplement the state insurance if they want to go to more expensive providers, in other words you could choose the amount of health based taxation you pay.

There would be some problems as you’d get towns where there was effectively only one healthcare provider, which would be pretty much a monopoly and no doubt you would get healthcare provider companies who would buy out competitors, so I would expect there to be some form of market regulation.

A system where the healthcare provider could go bankrupt, along with some anti-trust legislation might help keep the system getting the bloated administration and support that many hospitals in the UK have.

I think the most important thing though, is to keep healthcare out of the political realm of influence, because meddling by politicians is a sure way to screw the whole thing up, this we understand all too well in the UK.

13

Even if you can’t afford them? I know that hospitals will treat those who turn up injured and are in dire need of care, but how does it work in the US if it’s a long term problem - like a premature baby whose parents don’t have health insurance, or someone hit by a car that needs to be put on life support?

14

I’m two years from Medicare and I’d go for this. I’m far from rich but I’d be willing to pay a reasonable amount for health care and prescriptions.

I watched the Frontline special last week. Here’s a link to an overview of the health plans of the five countries they visited. It looked like a good deal for everyone except the doctors, who aren’t doing as well financially as US doctors.

15

Hospitals can’t refuse to try to save a preemie just because the parents don’t have insurance. Patients just owe a lot of money afterwards, which can indeed become a huge problem. Hospitals will generally try to set up payment programs (say, $100/month, for example) and work with the patients. The high costs in hospitals are partly due to the fact that they have to cover the losses in unpaid bills.

Insurance companies can refuse to cover certain treatments they deem unnecessary, but hospitals can’t (AFAIK) refuse treatment because of inability to actually pay for it.

16

The only way UHC can work is by controlling cost and the best way to control cost is to control profit. We are the only developed country that does not negotiate a price for drugs with big pharma. Insurance companies make huge profits on what should be a basic human right: health care. People need to make a choice. Do they want to continue lining the pockets of insurance companies that do everything in their power not to pay for care and have become cost prohibitive for millions of working Americans. Do they want to pay the maximum price for drugs so that the pharmaceutical companies can make astronomical profits that are invested in massive advertising campaigns while research is outsourced?

Control profit and create a compulsory social health fund with everyone paying into the system and UHC can work. It has to be well funded, so I say no opt out. This can be achieved but it is a choice. I hope most people decide it is a good and necessary choice to have a healthy citizenry.

17

Do you have any cites that show that ‘profit’ is what is causing high health care prices? Is it your contention that non-profit and government agencies are therefore more efficient at controlling costs than is private industry?

18

I cannot speak for the UK and other nations with nationalized health systems, but here in Canada, if you’re 80 and have cancer, then is is legislated that you receive care. From the Canada Health Act:

This is from a page explaining the Act; in the interests of time, I didn’t look into the actual text of the Act, but it’s in there somewhere. So if you get cancer at 80, you’ll be looked after; if you’re a very premature baby needing expensive care, you’ll get it. “One hundred percent of the insured residents” means just that; it doesn’t make an exception for a judgment call on a doctor’s part as to whether the patient will make it.

As to the OP, I think one very important lesson that the US can take is that it should stop thinking of it as national health care, and start thinking of it as a state health care system. Creating one single plan run from Washington for all three hundred million Americans would just be too unwieldy, it seems to me. Here in Canada, we do it at the provincial level, and it works (not always perfectly, I will admit, but probably better than if it were administered from Ottawa, given the size of our country). With some American states at or over the population of various European countries, it would seem to me to be a no-brainer that for efficiency’s sake, you’d run the system at the state level instead of at the national one.

19

My mother is 70, and suffers from macular degeneration. She needed several operations to correct her eyes - and she wound up on a waiting list for months for each one. She was essentially blind between operations, so the health care system’s answer to that was to turn her over to the institute for the blind, which provided her with a white cane and a reading machine. It took her over 2 years to finish the set of operations and get her vision back (partially).

My grandmother had a bum knee and couldn’t walk with it. She had to hobble around for a couple of years before she could get through the waiting list for an artificial knee.

These are the kinds of people who really suffer under national health care - people who need ‘quality of life’ treatment. Acute care gets reasonably well treated, but god help you if you’re elderly and need arthroscopic surgery or a hip replacement. And this is going to get worse as the baby boom retires.

How many Americans would tolerate that?

20

:eek: That’s great for Maine, but the mess that California would make of a state health care system boggles the mind. I’ll have to move to…hmm…Saskatoon maybe?