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

Great Debates
81

Actually, you’ve put your finger on the biggest problem with the US system. Most people get their insurance through their employment. This is terrible for many reasons, but most of all due to lack of portability. Why is it this way? It’s another problem created by government. Employers should NOT get a tax deduction for health insurance coverage that is not available to the general public. The ineptness of our government in handling simple things like this is a huge red flag to allowing them to handle health care coverage for the entire population. Our federal government is totally incompetent for this type of thing and I’m shocked that any thinking person could not see this.

In my opinion, the best way to handle health care coverage is to provide a refundable tax credit to everyone to go get the insurance of their choosing. Furthermore, lift the absurd regulations on the insurance industry so that a person can choose what their coverage consists of (e.g. a 60 year old woman might not want pregnancy coverage, etc).

82

Actually, you’re wrong on three counts. First, I said I never paid a doctor’s bill. That’s true. Second, though I paid the VAT on purchases, I wasn’t earning an income so one could say I really wasn’t paying taxes. Third, I was a student, so I wasn’t poor by American standards. I would not have qualified for Medicaid, but I did qualify for NHS. So I was really a free rider, and I think Britain did the right thing by giving me all sorts of inoculations and prescriptions so when I went off traveling in third world countries, when I came back to the UK, I wasn’t sick and a burden on their health care system, nor did I pass any dreaded tropical fevers to my fellow students.

I want a car that gets 40 mpg, has leather seats, a navigation system, and only costs $9,000. You simply can’t expect health service to cover more people, cost less, and maintain identical standards. It is completely unrealistic. The people who aren’t covered are in all likelihood higher cost patients. If you cover more sick people, either costs are going to go up or service is going to go down. There’s no such thing as a free lunch.

83

How is this inept on the part of the government? You might disagree with the policy, but it has been handled competently. I know it is an article of faith for you people that the government can’t do anything right. In fact, Medicare is far more efficient than private insurers (the cites have been provided many times) and Social Security, within the bounds of what it is supposed to do, works great.

I agree that private insurance was a mistake - if we started with a single player plan in the early '50s we’d be far better off.

The tax credit will help the working poor, who pay little in taxes, a hell of a lot, won’t it? The reason everyone pays for everything is to spread the risk. The 60 year old woman no doubt got the benefit of the pregnancy coverage when she was 25 , before she probably paid in enough to cover it. Now she is paying back the insurance company. She shouldn’t complain, because the 25 year old is paying for the treatment of the problems the 60 year old has now.

84

Heh. When I took Econ 101 I came in, straight from watching Star Trek, and disputed that there will always be shortages. I learned better.
I can look it up, but there is a long running problem of health care in rural areas, where doctors are not going to make the big bucks. I believe that there is a GP shortage in the US, since GPs don’t make the money, or get the prestige, of heart surgeons. Is there something similar happening in England?

85

I would recommend a nationalised health care system, but not the U.K.'s. Simply, we cover too much and too widely.

There are three questions you need to answer: “Who is covered?”, “What is covered?”, and “How do we pay for it?”

The second question is by far the most difficult. Where do you draw the line? (Can be phrased as how much can we afford?) Accident and emergency only? Tattoo removal? Psychoanalysis for everyone? Geriatric care?

86

The ‘what is covered’ question raises the most worries for me.

Abortions?

Contraceptives?

AIDS medications?

Will new administrations come in and impose their own rules on what is covered and what isn’t?

87

Well the Japanese did exactly that. Something like an MRI costs 1/10 of what it does in the US because they developed cheaper MRI machines.

Again, as far as just insuring the uninsured we’re down to adult-near poor people. We’re already paying for them indirectly in unpaid hospital bills. The goal is to make insurance affordable. When I checked on private insurance I found it quit reasonable to buy except … I was rejected. No counter offer or explanation was made, I was just rejected. Fixing that alone will increase the number of people insured.

So now the number of uninsured is smaller. What will it take to get the price down for some of them. What will drive down the cost of health care and therefore, insurance. Streamlined billing, cheaper procedures, cheaper tools…etc.

There are general practice doctor’s who charge $50 for their services but they only accept cash. The savings in billing is passed on to the consumer. Take the same doctor and lower his insurance due to tort reform. The price comes down. Take the same doctor and reduce the cost of his tools. The price comes down. Take the same doctor and reduce the cost of his degree. The price comes down. All these things are investments that continue to save money.

The more people who can afford insurance the lower our overall costs will be. If we take the write-offs that hospital’s charge to the paying customer that savings can be passed on. It’s a win/win if done right. This is what the Japanese have done (among other countries) and this is what this thread should be exploring. We have the opportunity to take the best parts of other national programs and build a new one.

There will always be the poor and disaffected and we will always pick up the tab. The goal should be to lower the overall cost of health care and increase the number of people who can pay for their own insurance. The advantage of doing this on a personal level is greater choice of care. The insurance I needed at age 21 is different than the insurance I will need at retirement. I can allocate my resources to get the health products I want.

88

I’m going to borrow part of your premise Magiver

You state that healthcare in the UK is rationed, and go on to say that if you can afford it, then healthcare in the US is not.

I can take out medical insurance in the UK, pay with my very own money, and get all the advantages of the US system in terms of waiting times.

So if I can do the same thing in the UK as I can in the US, and get the same result, I do not see how you can say UK medical care is rationed without then admitting that US healthcare is rationed - unless of course the rationing factor is money.

I can choose to remain within the UK NHS system too, and pay nothing at the point of use, and then wait in a line if that is the policy.

The only differance between going for personal insurance, and National Insurance, is my ability to pay - and in the US you have very similar options, you can call it medicaire if you wish, you can mention certain insurance products, but ultimately the service you get will depend upon what you can pay.

If we were so disturbed by the performance of our healthcare system, then market forces would ensure that many more of us would go for our own insurance.

What we do have is an under resourced system, but along with that - our system truly does not have a business discipline on costs and the effectiveness of its operatives at just about every level from the cleaner right through to the chief executive.
If we did have such a system, where healthcare providers could go bust, where patients could freely move their business then there would be plenty of deadwood removed from the UK NHS.

As I have mentioned, there was an attempt to try out an internal market, but it was based on cutting resources to the NHS even more, and it used the very same inept directors of hospitals as it was trying to drive out. No wonder that it cost even more than the pre-existing system, and this took even more resources from medical care.
What was worse was the the political administration that tried to implement this incompetant model put in their pals in charge as Chief Executives who supported the political party, and whose qualifications appeared to be based solely upon loyalty to that political party.

I would be interested to know what sort of income levels and the absolute numbers are that you would term as ‘near poor’.
It’s pretty glib not to give actual figures here because it is really the main event in this debate, if those numbers form a significant percentage of the US population then it shows that the US model is failing many of its citizens.

89

Waiting over a year for a hip replacement is rationing. Waiting 2 hrs in an emergency room because you’re too cheap to take a bus to the doctors is an infinitesimal inconvenience. So lets put this semantic dance to rest and set a timeline of service-to-need as a qualifier. Any non-emergency requirement that cannot be met within a week is rationing. But let’s be clear, “cannot be met” means no alternatives. Example: My family doctor made an appointment for me to see a specialist. The wait was something like a month. I canceled the appointment and found someone who could see me at my convenience the same week. If I don’t need to see someone for a month then I don’t need to see them at all.

90

I tried surfing for US delays and honestly, I don’t think there are any appreciable delays to account for. If you need it, you get it (and the bill). What I’ve seen, and also heard personally, are paperwork quagmires in Medicaid. I don’t know if that’s the government’s fault or ineptness on the user.

I’m not tring to avoid your question because I’m interested in the same information. It may be that the threshold of bitching hasn’t been reached on a trackable level. I don’t know what the social threshold is. Mine would be a delay of more than a week. I’d like to see any delays listed in units of weeks.

I would point out that people come from Canada and the UK to get procedures done so that in itself suggests we don’t have a rationing problem. If you need your hip replaced there is somebody available in the United States to do it on request.

91

I find it really, really hard to believe that an uninsured person or someone on Medicaid can get a hip replacement in the US with no problem, no waiting and then just not pay. I strongly suspect that there is indeed no waiting list for these patients – because there is very little possibility of them getting the operation in the first place.
I googled “hip replacement Medicaid” and got quite a few instances of people on Medicaid who cannot get this operation. It seems to depend on what state you’re in, and other non-medical factors.
From this site:
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb34.pdf.
“Medicaid’s share of stays ranged from about 6 percent to 8 percent
for these three procedures(hip replacement). Uninsured hospital stays for musculoskeletal procedures were very uncommon—less than 1 percent for knee arthroplasty and hip replacement procedures.”

Yes, a Canadian can go to the US for a procedure. IF THEY HAVE THE MONEY.

Bottom line:
Have money or insurance = no waiting in the US
Have no money or no/inferior insurance = no operation in the US
Everyone in Canada = wait list for non-life threatening conditions, everyone gets treated the same.
It’s a completely different philosophy at work that somewhat reflects the difference in the two countries;
US - Health care is a commodity that must be paid for by consumers. Private companies are good, government is bad and inefficient. It is up to each individual to make sure they are looked after.
Canada - Health care for all is for the common good of society. People are willing to pay taxes in order that everyone is covered. Medical care is to be given to people who need it, even if others can afford to pay for it. Jumping the “line” is frowned upon.

92

The thing is, those that come to the US to obtain treatment do so with their own financial and insurance arrangments.

They could do the same in the UK, the waiting list for those who have medical insurance is significantly less, and very close, or equal to that of the US.
In this and in other medical conditions, if you have the money and/or insurance, you hop over the waiting list so again I say that it isnt rationing of medical care that is the problem, its the ability to pay.

The reason that they come to the US is not just based upon waiting times alone, there has to be another reason.

Some medical insurance policies offer the option of travelling to other countries, this is done to reduce premiums by accessing treatment at lower cost, and UK privately insured citizens can go to countries as far as India, to European mainland, and no doubt to the US. There is a whole debate about the advantages and disadvantages of travelling large distances for serious invasive surgery.

Take a look at this,

http://www.medical-tourism-india.com/india_vs_uk.htm

You’ll note that even in the US, waiting times for certain operations as selected by the website promoter are much lower and so are the costs.

I would not recommend the UK as a model of socialised medicine but it has certain points in its favour, but equally, the US has serious problems too, and rather than the US try to bury its head in the sand about such healthcare systems, its planners should take a serious look at the advantages and weaknesses and make contingency plans, because ultimately its the US voter who will decide, - learn the lessons early.

93

Not so. I had a sebaceous cyst on my back that got inflamed, and was painful. I had insurance. I still had to wait about 6 weeks to get it removed.

94

I don’t know how they’d count people who choose not to even try because of cost reasons. I doubt any one facility schedules based on ability to pay - the problem would be that underfunded hospitals would have longer waiting times due to lack of staffing.

A few years ago my rather large medical center was low on GPs, and getting a checkup took a long time. I’m sure I might have been able to do it sooner if I really pressed them, or went somewhere else, but delays of over a week for non-emergency procedures are pretty common. I’m not complaining, especially when the procedure is a colonoscopy.

95

Please note that I said refundable tax credit, which would help anyone whether they pay taxes or not.

96

Rationing doesn’t mean that someone can’t get a service, just that it gets more expensive at times. Like spending time and money going far afield when no local doctor takes Medicaid. Or putting it off altogether.

The last time I tried to donate blood I got rejected because of a racy pulse. I was damn sure that it was due to the Mountain Dew I drank at lunch, but because a doctor visit is only $10 I went, mostly to get a letter saying that I could give blood. I’m pretty sure that if this was going to be a cost issue, I wouldn’t have bothered. It turned out that I had atrial fibrillation. If I didn’t have insurance, I could have keeled over dead at any time. Yeah, I could have gone to the ER, or spend an hour on a bus going to a doctor who would take Medicaid, but would I? Not likely. My wife is a medical writer, and even she didn’t panic (for once.) This is the kind of thing I mean by rationing.

97

I guess it all depends on what kind of insurance you have.

I’m sure that there are lots of other examples of wait lists for non-life threatening conditions in the US.

In Canada, wait lists became a “hot-button” political issue for the provinces a few years ago. You can believe that the politicians have been trying to work on solutions. There is also the Canadian Institute for Health Information (CIHI) that tracks wait lists across the country.

I’d rather have people wait for treatment for quality of life procedures than have a significant portion of the population get no treatment at all.

98

I never heard of such a thing. One of my great-uncles had cancer surgery past 90, and one of my great-aunts heart surgey around 85. Never heard of no attempt being made to save an early prematurate, either (no personnal knowledge here, but I would expect upset parents to spead their bile in the medias if it were to happen).

I dont know for other countries, but I would be surprised if such things happened in other west-european countries (even though I heard at some point in the past that some surgeries had been denied in the UK to heavy smokers, for instance).

99

AFAIK, this is yet another of those things that come up during debates on universal health care that is simply not true.

100

It’s frequently mentionned that one of the drawback of the american system is preisely the overhead administrative costs, due to each insurance company having its own gigantic bureaucray, and the MDs having to hire whole staffs to deal with these various insurances, each with its own rules and forms.

The rule here, as far as I can tell, is one secretary in a medial cabinet (for 1 to 3-4 doctors, depending on the cabinet). And as for the paperwork, it consists in the doctor filling a standart form with the code of whatever they did, the amount they charged and their signature. Actually, now, generalists don’t even do that, they fill the equivalent of the form on a network, and the reimbursment comes automatically on my banking acount, so I’ve nothing to do, and the doctor not much.

By the way, note that public healthcare systems aren’t all the same. In the UK, it is paid for by regular taxes and run by the State, in France and I think Germany paid for by a tax on salaries and run by representants of the employers and worker’s unions. I understand that in Canada you must register with a doctor and he is in fact paid by the government depending on the number of people registered with him, not on the basis of what he did, while here one can pick whoever he wants, and you pay the doctor for whatever he actually does when you actually see him. In some countries, there’s a private medical sector clearly separated from the public one, and the public healthcare system doesn’t cover it at all, while in others both the “public” and the “private” practitionners are covered. Actually, in France, outside hospitals, essentially all doctors are private practionners. In the Netherlands, the public health care system only covers people below a certain income, not everybody. And so on… This is a problem in such debates here because most posters have only some familiarity with the Canadian and sometimes British system (and I believe, maybe wrongly, that they’re quite similar).