Caught this a couple of weeks ago and have been meaning to post about it: It's a pretty good look at how some industrialized nations handle health care. It's by PBS. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ It's a 60 minute program. I have lots of thoughts on this, I'll post em tomorrow once some of you that care have a chance to watch it.
I'm guessing it's a 60 minute commercial for government-run health care. Pass. Let me know when they do a show on market-oriented health care.
Right off the bat, the "Fairness" category from that 2000 WHO report is cited. Of course, the "Fairness" category is "Fairness in financial contribution", which translated means "the category the pro-socialized-medicine WHO uses to punish the ranking of any market-oriented health care system." JMHO.
A street shot! Check out that Japanese honey! Edit: OK, it's the end of chapter 3, and I'm enjoying the program. Although that "PBS objectivity" (nudge-nudge, wink-wink) shines through, it's far less slanted than I expected. Definitely thumbs up to this point.
The code words--"how other industrialized countries" do it--are a tip off. If such a program FULLY critiques government run health care and acknowledges the areas where market-driven health care is superior, then I'll consider watching it. It isn't worth my time otherwise. I've already heard the arguments for socialized medicine and I reject them.
It starts with full on socalized medicine like that in England and then moves onto the mixed systems like Germany and Switzerland. They go into the problems as well the five countries highlighted in the program face with their each unique systems and what if anything we might be able to learn about our problem.
The WTO report on health care systems makes some bad assumptions--e.g., that life expectancy is purely a function of health care quality--and, while everyone's quick to point out that the U.S. ranks #37 in the list, it's never mentioned that it was #1 in terms of responsiveness.
To me, life expectancy is purely a function of personal responsibility. Pretty hard for a doctor to 'fix' someone who has fucked up his whole life by eating and living an unhealthy lifestyle.
Right. If I live in a country where the diet consists of red meat and fettucine alfredo but MRIs are plentiful and heart surgery routine, is my health system REALLY worse than some other country that doesn't have those things but, thanks to a better diet and a less sedentary lifestyle, the people live a few months longer on average?
Frontline is generally pretty evenhanded and fair. And I say that as a conservative who's in the same business they are. They do some of the best journalism in the country (teevee or print), IMHO.
That's all well and good, but one thing the program rightly points out is we spend three times as much as some other rich market economes on health care and still have a huge portion of the population with no coverage. I guess now is a good a time as ever to share what reforms I think we need. I don't like the NHS system. As the program points out wait times for care there are absurd and would never be accepted here. Taiwan's system requires too much bigbrotherism with the medical ID cards and visits from the gov't if you go to the doc more than 20 times a month. To me, I think two changes need to be made here. One, it worked in all four countries that tried it, ban profit from insurance companies only on basic care. All four countries in the program saw costs for care go down tremendously with no loss of quality. We have tons of elective health care stuff that will still keep the insurance companies fat and happy. Two, ban insurance companies from rejecting people with what they describe as "preexisting conditions." Three, gov't should pick up the tab for those who can not afford it. SCHIP already works here, so it would serve as a good model for health care for the poor. Four, lift limits on which states health care providers can operate. This will not only increase competition, but it will force states to have more uniform paperwork that will bring our absurd administrative costs down. I could not believe that over 20% of our health care money gets sunk into paperwork here while the featured countries all were under 9%. I think that's a good start.
Yes, but our system produces many of the technologies, treatments, and drugs that wouldn't be produced otherwise. By over-emphasizing fairness or universal coverage, a very important aspect of our system is being overlooked. No, since, as I noted above, the U.S. is #1 in responsiveness. I've got no desire to pay for my own health care PLUS someone else's then get to wait in lines for the priviledge. Banning profit is a bad, bad move. It's usually only a small percentage of the cost, but it's a huge incentive to improve or expand capability. Without profits, I'm highly skeptical that any organization will have any incentive to provide better, cheaper service. Perhaps for now. But profit is what causes GOOD CHANGES to happen. When someone's making good profits, competitors are drawn into the business. When profits are high, investments are made to increase the supply. If profit comes out of the system, systems may not adapt as they should. Also, I'm not sure why a private insurance company would want to forgo profit. That's certainly not a very good business model. I think I would have to oppose anything that took profits or competition out of the system. Yes, but if coverage for elective stuff went to shit, it wouldn't be so bad. That's the stuff I care least about. I want quality care if I have to go in for something that I DIDN'T elect. Okay, but those with preexisting conditions should pay more. If we're going to do this (not that I'd support it), I'd rather we just give the poor a "health care debit card" and let them go buy their health care on the open market. I don't see any need for bureaucracy beyond validating claims of poverty and issuing the cards. That I would support. I certainly don't want to pay for California's mandates in health care. LEGAL REFORM would probably be the place to address that, as I think much of that is just bureaucratic ass-covering.
I'm not sure where you get that from. We still have to make appointments to see specialists here if that is what you mean by responsiveness. We also typically need a referral from the PCP, like in the UK or Germany. Taiwan and Japan have no gatekeepers. In Japan you call one up and see them the same day. In Taiwan you can walk nto a clinic and see a specialist the same day. Unless you mean something different from the word responsiveness. All three of the countries that still have private health insurance that banned profit only on basic care have had it for years and in two of the cases decades with no ill effect on the quality of the service said companies provide. Instead of competeing for profit on basic care they compete for survival on basic care and in places like Germany profit on nonbasic care. That exact concern was one the Swiss had, a country very much like the US in its attitudes towards health care reform. None of those concerns came to pass, like other countries that adopted a non-DHS style of healthcare reform. By allowing profit on basic care it forces companies to exclude a huge portion of the population to maximize those profits. Also it incentivizes huge administrative costs to make a web confusion such that claim denials become very easy. The market should benefit both the consumer and the business like it does in most other cases. Here it just doesn't. See above. All assumptions that care with reform would go to crap are verifibly unfounded. Okay, but those with preexisting conditions should pay more. If we're going to do this (not that I'd support it), I'd rather we just give the poor a "health care debit card" and let them go buy their health care on the open market. I don't see any need for bureaucracy beyond validating claims of poverty and issuing the cards.[/quote] How the gov't picks up the tab is up for debate. I don't mind a kind of health savings account. I'm not sure of the mechanics behind SCHIP, other than it works. The States are going to have to swallow some pride here, IMO. This is a national problem and needs national solutions. This standard here different standard there is crap crap crap. [/quote] LEGAL REFORM would probably be the place to address that, as I think much of that is just bureaucratic ass-covering.[/QUOTE] The vast majority in $$$ of medical legal cases in the US are brought by people without insurance facing bankrupcy if they don't win. Can you blame them? They have no other alternative, even if their lawsuit is crap. Remove the specter of bankrupcy from health care and get all those people on insurance and this problem dries up overnight. Germans have very nearly the same rights to sue we do, but a the average German doctor's malpratice insurance is about $1200 a year, in the us it's over ten times that.
But it doesn't work better. Our system is #1 in responsiveness, just not in "fairness." Also, our system produces most of the medical innovations in the world. People who are free to choose--and have the money to do so--choose our system over others. Canadians do it all the time.
Define Responsiveness. As I said above there are areas where you can get care around the world at the same quality much quicker than here.
Here's a definition of responsiveness. My highlights are in bold. In other words, our system is very good at providing the things most Americans ACTUALLY WANT. It's only when you factor in "fairness," which is somewhat dependent on your point of view and "overall health," which isn't NECESSARILY directly tied to the performance of the health care system, that our score drops. Yes, our system costs more...but we get more. Setting aside costs and "fairness" for a moment, I think most fair and objective people would choose the benefits provided by private health care here than the NHS. Why wouldn't you want MORE options or FASTER service?
Japan and Taiwan are both universal health care and you have access to specialists same day without a referral.
Our system works if you can get care and that's the problem. Over the last 20 years the amount of people who can actually use the system has been falling like a stone. Not to mention the thousands of people who go bankrupt each year due to medical bills. One thing that the country is that we already have "universal health care" and "socialized medicine," we just do it in an ass backwards way focusing on expensive emergency care. The way all these countries cut costs was eliminating bankrupcies and getting everybody preventative care.
Sharing this New England Journal of Medicine study which compares per-capita administrative costs of the US and Canadian health care systems.
