ResearchBlogging.orgA dishonest campaign has started against healthcare reform in this country and the first shot has come from Conservatives for Patients Rights (CPR), a group purporting to show that patients in universal health systems suffer from government interference in health care. To bolster their argument, they have a pile of anecdotes from people around the world who have suffered at the hands of evil government-run systems. The problem, of course, is that anecdotes are not data, it is impossible to determine the veracity or reasonableness of these claims, and there is no way, ethically or practically, to respond to claims against doctors in these systems.

And should we be surprised? Every other country in the industrialized world has universal healthcare. Some are government run, single payer systems, others are mixtures of private and public funding to guarantee universal coverage. I would be shocked if you couldn’t find a few people to provide testimonials about how they’re angry at their coverage. After all, Michael Moore made an entire movie about such testimonials against our system.

So what do we do? How do we find out the truth when the ideologues and financially interested parties have started a campaign to muddy the water with anecdotal attacks?

We look at the data of course. And surprise, surprise it doesn’t support CPR’s assertions that our system couldn’t stand some improvement.

During the next couple of weeks, I think we should talk about what healthcare looks like here in the US and around the world. Rather than a few horror stories, let’s take an in-depth look at what’s happening in universal systems, and whether or not we should consider a change.

Let’s start with an examination of some data from the literature on different experiences people have with these healthcare systems.

The usual complaints levied against the universal systems are that they will ration care, you have long waiting times for doctors, and quality of care then suffers. It seems to be a given that in the United States with our private system that we have better access, better quality, and fewer mistakes. But what do the data show?

Let’s start with the Health Affairs article Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007[1], a survey on healthcare experiences in the US, versus the universal healthcare systems in the UK, the Netherlands, Germany, Australia, New Zealand and Canada. These systems are highly varied, and I hope to write about their benefits and drawbacks in the next few days. But briefly,

  1. the US is a non-universal patchwork of public and private spending, drugs and procedures may be subsidized by insurance
  2. the UK is completely single-payer with private care as an option, all drugs and procedures are paid for
  3. Canada is single-payer with provinces deciding how health care is spent and strict limits on private care, prescription drugs are heavily subsidized,
  4. Australia has a public baseline access to physicians with subsidization of private insurance and option of private care, prescription drugs are heavily subsidized,
  5. New Zealand has universal public health care, primary care and prescription drugs are subsidized with some cost sharing, and private care is an option
  6. the Netherlands has a system of obligatory private health insurance (like a nationwide Massachusetts system), premiums have a flat rate for all citizens, with subsidies for poorer people who can’t afford insurance premiums. Individuals pay for about half, and employers pay for about half, with government making up the difference.
  7. Germany has a system of mandatory insurance with purchase of access to one of several hundred “sickness funds” paid for by employers, there is a private option for those who afford it, and those who cannot or are unemployed are subsidized by government.

Each of these systems is very complex, most are a mixture of public and private hospitals, and public and private insurance. Universal health insurance, it should be clear does not mean we have to have a single-payer system like Canada, or like Britain as the anti-reform ads would suggest.

In their first figure, this table is a comparison of the per-capita costs of the different healthcare systems.
i-7f6d539e464db886003a2eb7229e9ff0-HFA1.gif
Note the United States spends more per capita than any other system and not by a small amount. We spend almost twice as much as the next nearest spender, Canada, and this without covering all of our citizens. We also spend more of our GDP than any other country, almost twice as much as any other country. Note, most other countries have a high percentage of patients enrolled with electronic medical records, a system that makes sharing of information between facilities (currently a major cause of redundancy in expenses) more efficient. Note also that universal doesn’t require primary care providers be the gatekeepers. Other systems exist that allow self-referral to specialists.

The Commonwealth Fund, which sponsored this study, has a figure in one of their online chartbooks of health data that summarizes how we spend nicely.

i-880005398336c472547ab02e425e6cd0-commonwealthfigureII8.jpg

The entire presentation is fascinating and worth a look if you have time. Almost universally we pay more for less. We pay more per capita for fewer hospital beds, we pay more per capita for fewer ICU beds, and pay more for ICU stays despite patients staying for fewer days, we have far fewer long term stay facilities, we spend more on fewer practicing physicians per capita, and for all that we perform worse in indices of mortality, and control of chronic disease.

But are people happy with these systems? Not surprisingly, no one is ever really happy with their healthcare:

i-731352c1510b906b808a62380e90da02-HFA2.gif

Almost all systems have a high number of citizens who think it needs significant changes, although only the US system has a 34% rate of people desiring it to be completely rebuilt, almost twice that of any other country. For the most part, the belief that their medical systems will provide high-quality, expert care, is similar across these countries. This table addresses another critic complaint though. What about wait times? Some countries do have a clear problem with elective wait times for surgery. Canada and the UK are the worst in this regard, but several universal systems have wait times that appear to rival or surpass those in the US. Worse, US citizens complain more of access problems than any other country, with 37% of respondents forgoing care, not seeing the doctor or filling prescription because of issues of cost

Now, on the issue of access, despite claims to the contrary, in most of these systems access to a doctor is rapid, with appointments available in the same day:

i-83cf9a73790a8f72e1dcb9793c60ab73-HFA4.gif

In fact, aside from Canada, we were least likely to be able to get an appointment on the same day, and most places could provide access to a doctor in an ER faster than in the US. So is access really worse in universal systems? It would appear that in most universal systems, doctors in clinics and the ER are more available than in the US.

The remainder of the data compares perceived quality of care, and coordination of care between primary care and specialists, and for the most part, the systems are equivalent according to the subjective experience of those surveyed. In the US, there were more complaints about expense of prescription medications, and poor coordination of care – I suspect due to poor penetrance of the electronic medical record.

So, after seeing some data on more than the few horror stories from health systems around the world, are you convinced that universal systems will mean longer wait times? Poorer care? More expensive care? I believe the data suggests more people around the world in these systems experience less of these problems than those of us in the US. We spend more, almost twice as much as any other country. Despite that, our wait times for physicians are worse, we pay far more out of pocket for prescriptions and copays than any other system, we spend more on administration of health care than any other country, we have more people who avoid seeing the doctor for fear of costs, and we are more likely to say we want our system scrapped. In an update to this analysis [2] the Commonwealth fund found that in deaths which were amenable to health care interventions the US performed worse than the other 18 industrialized countries to which it was compared. If we performed as well as one of the top three countries, we would eliminate about 100,000 excess deaths a year. Which is the real horror story?

The plural of anecdote is anecdotes, not data, so don’t believe the horror stories, look at the total experience in these systems to find a better approximation of the truth.

[1]Schoen, C., Osborn, R., Doty, M., Bishop, M., Peugh, J., & Murukutla, N. (2007). Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007 Health Affairs, 26 (6) DOI: 10.1377/hlthaff.26.6.w717

[2]Nolte, E., & McKee, C. (2008). Measuring The Health Of Nations: Updating An Earlier Analysis Health Affairs, 27 (1), 58-71 DOI: 10.1377/hlthaff.27.1.58

Comments

  1. #1 SLC
    May 22, 2009

    It should be noted that we already have a single payer system for seniors called Medicare which is in serious financial trouble. There is no guarantee that if the US went to a single payer system, it would be adequately financed. The experience from the Medicare system suggests otherwise.

  2. #2 Martin
    May 22, 2009

    A lot of us British people have been bewildered by the attacks on the NHS from right-wing Americans given that we are a healthier nation than you are, live longer, and pay less money for the privilege in spite of having generally higher costs of living than you do in the States.

    Having said that, as SLC points out, there’s no guarantee that switching to a more modern system would work in your country.

    For me, the thing that bewilders me about U.S. politics, is why you’re not out on the streets marching – both parties – over the ridiculous amounts of money your government spends for so little benefit. Any reconstruction of the U.S. health system needs to begin with the simple question: “Where the fuck is all that money going.” Unless you can answer that and stop the rot, you’ll have the same problems regardless of having universal health care or not.

  3. #3 humorix
    May 22, 2009

    (France) 1 branch of glasses $21 ! (2 = $42) at the optician. Africain market $7 a pair of sunglasses.

  4. #4 Fred
    May 22, 2009

    If you would like to help pressure Congress to pass single payer health care with your vote please join our voting bloc at:
    http://www.votingbloc.org/Health_Bloc.php

  5. #5 zack
    May 22, 2009

    Medicare is only going broke because the people who use it are all over 65 basically need health care. If everyone paid in and drew from it, it would be like a large group plan where only some people needed the coverage at certain times. Now the majority of that group needs it. No wonder it is going bankrupt.

  6. #6 zack
    May 22, 2009

    Medicare is only going broke because the people who use it are all over 65 basically need health care. If everyone paid in and drew from it, it would be like a large group plan where only some people needed the coverage at certain times. Now the majority of that group needs it. No wonder it is going bankrupt.

  7. #7 Eric Lund
    May 22, 2009

    Martin: The lack of agitation for single-payer healthcare from the US business community also puzzles me. Those of us in the US who have health insurance and are under 65 generally have it via an employer, who pays a large share of the cost. This cost puts the company at a significant disadvantage compared with companies in other countries who do not have this expense because the government takes care of it. That’s part of the reason why the Detroit automakers are in such trouble: instead of taking the advice of labor leader Walter Reuther fifty or sixty years ago to promote such a system, the automakers chose to pay for employee health insurance, and as Reuther predicted, it’s bankrupting them.

    SLC: Zack is correct here. Medicare suffers from an adverse selection bias, in that people over 65 are disproportionally likely to need health care, and the care they need is disproportionately likely to be expensive. Covering younger, healthier people can only help.

  8. #8 Zeroth
    May 22, 2009

    Very good paper you found. I was just thinking about this very subject a couple of weeks ago, but I didn’t do anything about it.

    The fact is, for every horror story they may quote(they being whomever attacks universal health care for any reason) there can be quoted great stories. Anytime anyone quotes a horror story at you, consider this:

    I’m a student, and really quite poor. I’m living off of credit until I get paid later in the summer. I can go to any doctor I want in this city. I give them my name, they find my provincial insurance info, and the visit is paid for. I’ve had multiple surgeries on my feet, with only a $25 copay for them, scheduled when it was convenient for me. I’ve been able to go to the nearest clinic to me several times these past weeks, and paid nothing. I had several blood tests and a follow-up visit. I paid nothing.

    Not only that, but the clinic only has 2 secretaries, mostly to schedule appointments and coordinate rooms for patients. The people are friendly, helpful, and I get served relatively quickly(most days about an hour).

    The fact is, anecdotes isn’t data, because for every horror story, there is an angelic story. Thus, a preponderance of horror stories can be countered by a preponderance of angelic stories. But the data can’t lie(unless its been manipulated to do so).

  9. #9 MarkH
    May 22, 2009

    This is not about single-payer insurance. The majority of the countries in this survey are not single payer, only Britain, NZ and Canada are. This is about risk equalization and control of costs, which is what the US fails out.

    I’m rolling out about half a dozen posts on healthcare around the world to demonstrate this. We do not need single payer to save money and get high quality health care. If anything, the single payer systems perform worse than the mixed public-private systems.

  10. #10 David
    May 22, 2009

    Let me offer two of mine own anecdotes. I have an existing health care condition that insurance will not cover. When I was in Europe (Holland) I needed treatment and even though I was a US citizen the lady at the counter in the hospital smiled at me and told me to sit down. The treatment was wonderful and the people were kind. And it was hard not to notice how happy everyone in the waiting room was. I guess that’s how people behave when they don’t have to worry about being able to pay for health care.

    I have had to make two trips to the hospital here in the last year for the issue. In each case a 1-2 hour visit cost me $6000. INSANE. Unless these types of costs can be fixed nothing is going to save us.

  11. #11 Who Cares
    May 22, 2009

    As a dutch citizen a few things:
    Biggest complaint about the system is that for surgery the waiting times are so long that for some type of operations people go to Belgium or Germany.

    ER waiting times are dependent on the initial severity of and location of the injury. You get directed to a treatment room fairly quickly but once there it can take several hours if your injury is minor from initial diagnosis to treatment.

    @Eric Lund:
    The disadvantage angle is bullshit seeing that governments need to get the money to pay for their part from somewhere which means taxes which in the end are (in)directly coughed up by said companies.
    The problem is that companies in the US pay 80% to 100% more in health care then the other six countries in this study.

  12. #12 John
    May 22, 2009

    One comparison I don’t often see made is between human health care and veterinary care. Especially with regard to payment options since there are no federal allotments for doggy health care and few private insurance options.

    I’ve had my share of medical problems throughout life (epilepsy, appendectomy, and an unknown stomach ailment that came close to killing me), so I’ve dealt with quite a few doctors and hospitals in three U.S. states. In addition, my dog recently had part of a disk in his spine disintegrate and pinch off his spinal cord. He was paralyzed from the waist down. I took him to a vet hospital that day, got him treated, and after surgery (with several months of in home rehab) he is up and running again.

    While he was being treated I noticed several differences between how I was treated as a patient and how my dog (and me, as his owner) were treated. First, when my dog was in the vet hospital I got daily calls from the doctor updating me on his condition. Second, while the treatments were out of my price range they were still significantly less expensive than the human equivalent (are dogs’ spines significantly less complex than human spines?). Third, everyone was much more kind, considerate, and helpful at the vet hospital.

    I wonder if they have any studies of how satisfied pet owners are with their pets’ treatment at vets offices and vet hospitals? ;-)

  13. #13 hipparchia
    May 22, 2009

    We do not need single payer to save money and get high quality health care. If anything, the single payer systems perform worse than the mixed public-private systems.

    This is only sort of true. The mixed public-private systems in other countries are much closer to being single payer than to being a system like ours.

    In other countries, the ‘private’ insurance companies are non-profit, they are told by the govt what premiums they can charge, and they are told by the govt what benefits they will offer in their plans. These companies can then sell, on a for-profit basis in many cases, supplemental insurance over and above what their govts decree to be the basic required insurance. Additionally, in all these other countries, the govts basically tell the drug companies, hospitals, and doctors how much to charge. This makes them much like Medicare, our own homegrown single payer system, which is paid for with taxes, and administered by third party contractors under the supervision of the govt, and in which the govt basically decides what it will pay to the doctors and hospitals.

    You do hear a lot [too much, it’s over-hyped] about the waiting lines in single payer countries, but there are disparities in access to care in other countries too. You don’t hear as much about that [my guess: it’s because insurance companies deliberately want to demonize single payer].

    It’s true that you don’t have to have single payer to get quality, affordable health care, but in the multi-payer countries one of the things they do to equalize out the risk pools [so that no one company gets stuck with all the sick, expensive folks] is basically reinsurance, which just adds another layer of complexity — and cost — to the mix. You don’t have to have multi-payer to get quality, affordable health care, and why would you when single payer is available and costs less?

  14. #14 Whitecoat Tales
    May 22, 2009

    @John

    I speak as a Med student who is engaged to a Vet student so I know a little about this (not rigorous science, just anecdote).

    The vet system isn’t super overtaxed.
    In human med, a large portion of the spending is on the last few months of life.
    In vet med, a large number of conditions that we treat in people, vets suggest euthanization.
    In human med, we accept very very low complication rates, on the order of frations of a percent.
    In vet med, they accept about a 3% (at my fiance’s institution anyway) risk of catastrophic failure in a given surgery.
    There is an amount of law of diminishing returns at some point, we pay increasingly more because there is an increasingly small rate of failure acceptance.

  15. #15 remy
    May 23, 2009

    I don’t know what all the hubbub about long waiting lines is about. To tell you the truth I’ve had several health issues, two ear surgeries, stomach and intestinal infections, a dislocated ankle. I’ve had to wait a LONG time in the waiting room on all these occasions. Guess what? I also had to pay a ridiculous amount of money each time. I’d rather have a mixed private public care system with non-profit insurance companies(like mentioned above) that is closer to a single payer system than our current mixed (albeit lightly mixed) system of medicaid, medicare, some state health insurance and mostly private insurance.

  16. #16 Boris
    May 23, 2009

    Excellent post as always, MarkH. I found this survey a few months ago and I’m glad you are giving it the attention it deserves.

    I do have a question as to why our system is more expensive. Obviously, increased administrative costs and inefficiencies are part of the problem, but what else makes health care more expensive here? Is it that we spend so much on developing new cures and treatments for “rich people” diseases while failing to effectively administer known treatments for more common diseases amongst the poor?

  17. #17 Dan
    May 23, 2009

    Fascinating data, but from a UK perspective some of the survey responses seem odd.

    8% claim they had some kind of access problem because of cost in the last year. This seems unaccountably high. The only national health service cost charged to patients is a notional £7.20 for a prescription, or £104 for a year’s “season pass”; people on low incomes are exempt. So either the survey responses are wrong, or there is a serious problem, e.g. with people on low incomes wrongly believing they cannot afford treatment.

    Also: 9% claim to be able to access their own medical records by computer/internet. I believe this is not something that is at all available in the UK (but if anybody knows better, please correct me)

  18. #18 John
    May 23, 2009

    Thanks Whitecoat. Sounds like a reasonable explanation to me.

  19. #19 Mark P
    May 23, 2009

    In New Zealand the medical system is untouchable politically. To move away from a basically compulsory-and-free system would be to lose a party power for a long time. (Private hospitals and insurance top-ups cater for the wealthy, so they don’t particularly mind the current system.)

    The level of dissatisfaction recorded (despite having good statistics) is two-fold. Firstly NZ is not quite as rich as the other countries studied, so we lag in our ability to pay for expensive drugs. This is a financial thing, not a system issue: France’s system is similar, but they can pay more for their health care, and thus it is better quality.

    But also there are serious political issues about how our hospitals are run. The level of satisfaction with the health boards is very low, but that doesn’t mean that scrapping public health is even considered.

    The most important thing holding back US medical costs, I suspect, is the legal system. In New Zealand individuals can sue for malpractice, but cannot gain monetary reward for doing so. So doctors and hospitals can function without the need for continual worry about law suits. They don’t need to prescribe every possible test and give the most expensive medicines, just in case. They don’t have to keep re-examining just in case. They don’t have horrific insurance costs.

    Costs of negligence in NZ are covered by the state, as part of the compulsory accident insurance. The system is simple and functions brilliantly.

    Remove malpractice suits, negligence suits etc, and medical costs in the US will fall drastically.

  20. #20 Ms. Sanity
    May 24, 2009

    Thanks for this article. I have been trying to “agitate” for Universal Health Care in the US for a long time. I too am like the other posters wondering why people (and businesses) are not out in the streets over this too.

    I’d love to hear the experiences of people in other health-care systems (via email or at http://www.sharing-circle.com) and especially I am looking for authoritative information on WHO MAKES DECISIONS in countries with government-run systems of health care. The popular argument here is that “Government bureaucrats will make decisions on what treatment you can get if we go to universal health care…” I don’t think that’s the case, but I don’t have hard data…

    Anyway thanks for your work here…

  21. #21 teenage dreams
    May 25, 2009

    Dan: Maybe access problems related to money are to do with dentistry? We hear it’s impossible to find an NHS dentist, although in actuality, when I needed one, I found one within a day, although there was still a wait of a couple of weeks. Which is reasonable, given that it was non-urgent, and there were options if it had been an emergency. I think maybe perceptions are the problem here – I had wrongly assumed I couldn’t afford to see a dentist (which I probably couldn’t have, privately), and that there were simply no NHS dentists available.

    Good post though Mark, as someone who works in the NHS, I’m pretty interested in how it compares internationally (and pretty disappointed by the seemingly constant disparaging of it by some sides of the political debate both in the US, and here in the UK).

  22. #22 Michelle Schatzman
    May 25, 2009

    Health care in France is a process with several tiers.
    Tier 1 : everybody gets basic healthcare, with good reimbursements for medicine, surgery, mental health, and bad reimbursements for dental, optometric, deafness. For anyone who is employed, the health system is financed in function of the person’s salary ; for someone who is retired, the retirement fund pays ; for independents, there is also a fund, with compulsory affiliation and payment. For unoccupied people, the unoccupation fund pays. For people without any resources, there is still a fund who pays – with the difficulty that the doctors who see them must not take more money than the publicly recognized fee. So some specialists refuse to see the very poor people.

    Serious diseases requiring lots of expenses are better reimbursed than ordinary diseases. The laws says 100%, it is not quite true, but very close to it. Five years of big bad cancer have given me all arguments to support this system, since the expenses on my disease have been close to my income of these five years. Not only did I get paid sick leave, but I also did not have to pay the 1200 euros (about 1500 US$) for each growth factor shot dedicated to boosting my white blood cells after chemo.

    Tier 2 : people can, but do not always subscribe to a mutual insurance fund. These can be non profit, or for profit. Mine is non profit, it reimburses rather badly optometry and dental, but it takes all my medical and pharmceutical expenses beyond the first tier and outside of cancer. It does not reimburse the higher fees that most of my doctors ask. Personnally I do not mind, but some people could mind. Hence, some of these mutual insurances do reimburse higher medical fees. When I am in hospital, my mutual insurance does not reimbure extra fees for a private room, unless it has a contract with the institution. In my area, it has contracts only with public institutions. I chose to be treated in the private sector, so most of the time, I am in a double room when in hospital. An exception : once I had a pretty bad infection, and I had a large room for two just for me, because of isolation rules. I did *not* complain, and I paid as for a bed in a double room.

    Significant problems in the system, right now :

    (a) demography of md’s is not properly managed, with the number of people allowed to enter medical school being set by the government without any kind of long term policy.

    (b) the density of doctors is quite heterogeneous, and in the case of specialists the problems became significant. For instance, there are regions with not enough heart specialists, hence the inhabitants are not properly cared for. There are other regions with too many heart specialists, with the consequence that they see their patients more often than needed, just to make a living, and
    this costs more than necessary to the health system.

    (c) there are no optometrists in France : the guy in the optics shop cannot prescribe your glasses. But there are not enough eye doctors, so there are enormous waiting times to see your eye doctor.

    (d) the first tier of the system is not financially balanced. In fact, it is always missing a few percents of its budget in order to be at equilibrium. For some 30 years, the attention of french citizens has been attracted to “le trou de la sécurité sociale”, i.e. the debt in the first tier of the system. In order to diminish this debt, lots of decisions have been taken, in particular decisions on the reimbursement of pharmaceuticals. But I must add that lots of decisions have been taken to increase the debt, such as increasing the minimum level of medical fees.
    What else? Presently the french system is in turmoil, because it has been rather badly managed by successive governments. I tend to think that most governments have had potato mash instead of brains in their heads, regarding the matter.

    A new law is on the point of being passed, and it does not look very engaging. It will create a much more centralized and authoritarian system. Also the payment system in hospitals (public and private) has changed. There is now a list of some 700 items for categorizing diseases, and therefore the spending decisions. Doctors complain that 700 is really ten times less then what they need in order to do a good job. I have not followed the debates from close, therefore, I have not made up my mind on who is right and who is wrong.

  23. #23 Dave
    May 25, 2009

    You have omitted how much people pay in taxes for these entitlements

  24. #24 Samer
    May 25, 2009

    I come from Canada where we have Universal Health Care. Sometimes I have to be honest get really annoyed by the wait times we have to put up with when getting health care. However, this is something I can and do live by because at the end of the day the system works. If you have a minor injury or sickness you are forced to wait but patients with heart problems, cancer patients, etc. get preferential treatment and everything is done to help them get through without having to deal with insurance companies denying them what they are fully paying for. I have seen countless stories of people losing everything to help a family member diagnosed with cancer or other fatal diseases and that is just not right. My father whom works abroad in the Middle East has insurance as there isn’t a universal health care plan for him as an expatriate. As such when he suffered a heart attack we had to sell our home to pay for his operation. When he came back to Canada all it costs for the consultation fees was a tank of gas. This is the truth behind universal health care, great doctors, great service your life and your pursuit of life and treatment is never denied.

  25. #25 BillDee
    May 25, 2009

    I don’t think anybody ever mentions this, but in all countries that I know of, and have lived in (over half a dozen), that have universal care, the government does NOT eliminate the option of private health care. Even in old Communist Poland, I had the choice. What happens, instead — and this is what doctors and pharmacorps don’t like — is that the private companies have to compete with the public health care system which not only works to lower private-care prices (how can you compete with free?) but at the same time raises expectations in the public sphere, so that the government is constantly trying to reduce waiting times,increase services and coverage, etc. A truly win-win situation for the ill, to be sure, but a lose-lose one for the medico-pharma complex. I’ll never understand why people writing about single-payer in the US always act as if they’d be forced to use public health care. No more than you’re forced to use the public education system.

  26. #26 Mark Jeffrey
    May 25, 2009

    With regard to how much is paid in tax, I think that is covered by the costs in the first chart. Tax levels are rarely broken out, and the tax regimes vary a lot, so you need to stick with the cost of providing healthcare alone. My own experience was that taxes paid in the US and the UK were pretty similar. In the UK I got healthcare. In the US I got aircraft carriers. Both are useful, but hardly helpful to compare.

    Now I live in Switzerland which is an insurance-based system, more like the US, but mandatory on all sides for basic healthcare as defined by the government. There are a lot of additional options for higher premiums, such as access to private rooms in hospital. All companies are required to offer basic cover to everyone who asks, though they can set their own premiums within limits. We have free access to any doctor or specialist.

    Switzerland has more doctors and hospital beds per capita than just about anywhere else on the planet. Everything is very efficient, but (in our experience) the doctors often dont bother telling you much. They expect you to just let them make all the decisions.

    There is a similar problem in Switzerland to the US, which is not mentioned in this article, in that it is very hard or impossible to find insurance for mental health issues, such as depression. By contrast, the UK, France and some others treat this as part of the overall health system. Mental health care has its problems, but at least it is paid for.

  27. #27 Patrik
    May 25, 2009

    I don’t see why the US doesn’t have universal healthcare already. In finland we have 100% coverage (even when travelling abroad!) and we only pay 5-10% more tax than americans at similar income levels. However, for the median income in finland that 5-10% works out at less than the average cost of a medical premium in a free market (its part of what is considered when tax rates are set for the coming year).

  28. #28 Nathan
    May 25, 2009

    Another important figure I thought was scary in the USA was the causes of bankruptcy: just over 50% of bankruptcies in the USA are from medical costs.
    It’d be interesting to see how that compares worldwide.

    But I think it’s pretty clear (as your stats show) that the current system leaves far too many gaps and costs far too much for a poor service.

    It’s also amazing the mindset difference when you don’t have to worry about the “benefits” part of a job. In the USA if you don’t have a job then you really can’t get hurt or sick..

  29. #29 Troublesome Frog
    May 25, 2009

    You have omitted how much people pay in taxes for these entitlements

    Argh! That isn’t the point. In fact, it’s 100% irrelevant. The relevant number is, what percentage of GDP is country X spending on health care? Whether that comes in the form of payments on private premiums, direct copays, government transfers, or sacks of money left at the sacrificial altars of the health gods, the point is the same. What percentage of your economic output goes to paying to keep your people healthy?

    By that metric, the US ain’t doing so hot no matter how you slice it.

  30. #30 MarkH
    May 25, 2009

    It’s worse than you guys think. We already pay for this in taxes! What do you think happens? Do you think hospitals just eat the bills (in which case you pay for it in higher medical costs)? Do you think we just let poor people die in the ER? Do you realize that most doctors sacrifice their time for indigent patients already and costs are distributed so they can do this?

    No, the government protects doctors ethical obligation to treat the sick no matter by protecting hospitals financially for treating those who cannot afford it. Doctors and hospitals already redistribute fees to cover money-losing services like mental health care and ERs.

    You pay for it no matter what. You can not avoid it. Doctors will not stop treating people if they don’t have the cash, and treatment costs money. If government becomes part of the payment structure, what happens is it can negotiate for lower costs (if congress isn’t hijacked by spineless shills for insurance companies like Lieberman). One of the main reasons costs are lower in other countries is that government doesn’t let insurance companies and drug companies gouge it. Sadly, with medicare part D, we do.

  31. #31 Eamon
    May 26, 2009

    Some ideas on why the US system’s costs are so high:

    1) Medical institutions and doctors have to pay for the costs of litigation insurance.

    2) Insurance companies have to provide profits for shareholders.

    Double whammy!

  32. #32 Dentist Melbourne
    May 26, 2009

    Health insurers and drug makers have showered Congress with almost $6 million bucks to have their seat at the health reform table.

  33. #33 Donna B.
    May 26, 2009

    It is not just wait times that contribute to a difference in care, though that is important. My sister is now a UK citizen, but we have similar genetically related health problems.

    For surgical treatment of her carpal tunnel/arthritis hand problems, she has had to wait 11 months. No interim treatment other than NSAIDS was available. My problems were treated immediately with cortisone and custom wrist splints. I do not need surgery… at least not yet and I’m 6 years older.

    High blood pressure: my sister’s UK doctors are happy with 140/85, yet that’s over the reading US doctors started treating me. Ankles and calves swelled to twice their normal size do not trigger treatment from UK doctors, yet my US doctors insist on treating swelling half, or less, than that. Regardless the implications on one’s cardiac or vascular health, her feet are PAINFULLY swollen and not only is treatment not offered, it’s explicitly denied.

    Are US doctors over-treating or UK doctors under-treating? Why are there such treatment protocol differences?

    Cost of medication does not enter into this scenario because diuretics are cheap. So, what gives?

    I fear the answer is bureaucracy. Guidelines are more likely to be rendered in concrete in such a system. Science-based medicine can be prostituted into efficiency-based medicine (though I fear that’s a huge misnomer).

    Averages and one-size-fits-all are more economically feasible, but they don’t result in good, much less better, health care.

    I’m not really dissing UK healthcare here as it provided my nephew with treatments that would have been extraordinarily expensive in the US (copays for them might have bankrupted some lower income families).

    What I’m questioning is whether the difference is monetary or societal? My nephew’s treatments were considered experimental in the US. Subsequent research (and my nephew’s outcome) have not exhibited improvement.

    Which system is better remains to be seen. Even the poorest non-insured person in the US is treated, though I wouldn’t say he is given the best treatment possible. If the UK system insures that everyone is treated, though possibly not given the best treatment possible… how does that compute to an overall improvement?

    From my view, overall treatment and costs are similar (though paid differently) in the US and countries providing so-called universal healthcare. The difference is solely within individual treatment protocols regardless expense.

    If I’m wrong, please tell me how… and if I’m right… what are the options?

  34. #34 dantel modelleri
    May 26, 2009

    Thank you for the summary we are going some justin tv for some one its really good…

  35. #35 Michelle Schatzman
    May 26, 2009

    You have omitted how much people pay in taxes for these entitlements

    The answer appears in the table that Mark H. has shown here. It would be extremely dificult to say how much of my personal taxes and pseudotaxes go into the french health system, for several reasons :

    – VAT tax is a large part of internal revenue ; but it depends on the kind of things I buy, since it has various rates
    – I know what I pay in direct income tax, but it is used for many other purposes than health and health expenses are funded mainly by a budget, which is not considered as state budget
    – my salary is discounted for social security benefits. This is a large amount (about 45% overhead), but most of it is not “mine”, since it is fiscally considered as taxes paid by the employer. About 10% among the 45% are “my taxes”, and appear as really discounted from my salary.

    These are really collective payments, with the obscurity and clarity of good insurance. Between 1968 and 2004, the social system paid two births and the occasional doctor’s appointment for minor problems. Now it is paying heaps for big bad cancer. Not everybody has big bad cancer lasting five years. Mine has a low survival rate at 5 years, say around 15%, so big bad cancer kills and thus benefits do not have to be served anymore.

    Re. why the US system is so expensive and gets rather mediocre results? I guess that it is a sector where capitalistic organizational logic has not been sufficiently developed.

    I am not kidding : why can’t individuals organize and conclude a group insurance contract with a health insurance company? The idea that independent workers are as badly off as the unemployed is deeply shocking.

    Besides that, not everything can be organized according to capitalistic organizational logic. It is clearly uncapitalistic to care for people who are going to die anyway. Since we are all going to die, why should there be any medicine or any health insurance?

    Whose greed can be satisfied, caring for people afflicted with an incurable, sexually transmitted, fatal disease, which affects all of us? [For anyone interested, this specific disease is called life.]

    The problem with the US health system is that the aims are not properly stated, the means are not deployed and the principles, which should balance between useful and useless care are not discussed as they should.

  36. #36 Cordic
    May 26, 2009

    The problem is this: the United States is none of those other countries, and it’s politicall incorrect to mention that the USA seems to have a lot more freeloader types. We also have a problem of too many politicians being completely insane and evil. Look at California’s legislature. They are corrupt to the point they might as well be a military junta for all that they listen to any of the voters outside of the ones that pay the biggest bribes.

    I’m curious to see how many of the EU systems fare over the next decade with their influx of poor immigrants and the integration of more Eastern Bloc countries (the EU charter of rights guarantees care in *any* member state).

    Don’t get me wrong. I generally support universal health care, but there’s a lot of things wrong in this country that could seriously monkeywrench any system we try.

    50% of bankruptcies in the USA are from medical costs.

    Here’s the core of the problem. A re-examination of the data (you’re referring to the Himmelstein study, yes?) suggests 17%. Still terrible, but everyone has their numbers, and all I can think of is Disraeli quote (popularized by Twain) about lies, damn lies and statistics.

  37. #37 BAllanJ
    May 26, 2009

    I would say that the biggest problem in Canada is how hard it can be to find a family physician that will take you on… there is a shortage. I think this has come about for a couple of reasons. Tuition for professional degrees was deregulated so the cost of a becoming a Dr went through the roof. When the new Drs graduate they have such a debt that they can’t as easily afford to work in Canada where the fees they can charge are far below what they can get in the US. Also, since the taxpayer hasn’t funded their education, they feel less like they owe it to Canada to stay.

    If the US is to get any big savings, they’re probably going to have to rein in Drs salaries/fees. If they do, then some of Canada’s shortages may go away.

    Some personal anecdotes: I was actually in my Dr’s office this morning for my 3 month checkup (I have diabetes so he wants to see me more often than an annual… and no he didn’t have to call the govt to ask if he could bill more often for me… his call). No charges, just had to show my card to his receptionist (he got a new one who didn’t know me, so I actually had to dig it out of my wallet)… even the parking was free and his office is on my way to work. When I was at emergency last fall and got stitches (a pox on anyone who designs modern packaging) I was seen by the triage nurse within a few minutes (quick look at my hand, evaluated blood flow and took my blood pressure and meds history), but I did have to wait a couple hours for the stitches due to a car accident and a few people ahead of me. I think I get good service from the system here. The current attempt to move to electronic records seems somewhat incompetent, but compared to what is wasted in some other systems I’m OK with them not being perfect in this.

  38. #38 Michelle Schatzman
    May 26, 2009

    Cordic : good question about the future of health care systems in the EU. Wish me something : to be there when it happens!

  39. #39 Michelle Schatzman
    May 26, 2009

    Cordic : good question about the future of health care systems in the EU. Wish me something : to be there when it happens!

  40. #40 Cordic
    May 26, 2009

    @#38 (and again @#39)

    Huh?

    I’m not making a dire prediction, but I am curious to see how well it takes the added load, that’s all. We can learn some lessons there as we try to construct our own nationalized system.

  41. #41 tatil
    May 26, 2009

    Thank you for the summary we are going some justin tv for some one its really good…’m not making a dire prediction, but I am curious to see how well it takes the added load, that’s all. denialism thank you

  42. #42 SimonG
    May 26, 2009

    Cordic: Regarding EU member states providing care for all citizens, I don’t see the problem. Provided my Polish plumber is paying UK taxes, then he’s contributing just as much to the NHS as anyone else.
    Some countries – Spain and France that I’m aware of – do have a problem with people from other countries retiring there. Obviously retirees aren’t contributing as much in taxes and have higher health costs. As I understand it, they do not necessarily get the same care as natives would and may face additional costs, (although in the case of UK citizens most of these can be claimed back from the NHS).

  43. #43 SimonG
    May 26, 2009

    One of the most surprising things to me is the amount of public money spent in the USA. You’re spending just as much out of the public purse as the other countries, then as much again in private spending. That’s staggeringly inefficient.

  44. #44 JC
    May 26, 2009

    Having lived in both the United States and Europe, I know that the American system is failing. And I think, at the end of the day, the root cause is greed.

  45. #45 Nico
    May 27, 2009

    I have a well managed but chronic illness. It isn’t ever going to go away, but it’s so managed that I have not been hospitalized in over ten years, asthma.

    But no insurer would touch me with a ten foot pole in the US.

    I have no real complaints about our canadian system. Sure, sometimes there’s a wait, but everyone I know and myself included, who has faced life or death illness: leukemia, liver issues, a brain abcess, has gotten the immediate, best of care and support financially during their recovery. they have not lost homes. they have not had to beg insurers for preauths.

    COntrast a friend of mine in the US who has had chronic leg pain for years now and can’t get a pre auth to see a doctor. Another had her visit denied because she didn’t get pre auth’d for seeing a doctor for a sinus infection.

    The canadian system might lack all that flash bang gee wiz that the US proponents claim, our hospitals might be on the older side, and maybe less luxurious, but frankly, they do a good job.

    I hear lots of people say that UHC in the US would mean rationing care to the elderly, that we do this in canada, tell someone grandma’s too old to sink more money into, but my grandfather had the best of care up till he died. No one rationed care.

    I wouldn’t consider living anywhere that doesn’t have some sort of universal system.

    Our household tax bill entirely comes out to less than what a lot of people I know pay in US medical insurance, and upside, I don’t have to beg to access it.

    In the ER one night with my husband who’d burned his hand, we saw a handful of americans get stitched up after some sort of competition, and the ER waived the fee as it wasn’t a huge expense, it wasn’t worth trying to bill and chase them down. They were pleasantly surprised.

    People argue that if it’s “free” people would abuse it, but for the most part, I haven’t heard of anyone getting extra colonoscopies for a larf.( I’m sure there’s the occasional odd duck, but that could be said of any medical system.)

    Anyway. Ours may have issues that vary region to region but it seems to deliver good service to a vast majority, most of the time.

  46. #46 RossM
    May 27, 2009

    It isn’t just the USA vs other countries. State by state comparisons within the USA (can’t recall the site just now) show huge variablity of costs between states with no pattern in terms of medical outcomes. The single figure that summarises health care is how long the average person lives. The USA spends a huge proportion of its GDP on health costs but delivers inferior results for its citizens in terms of life expectancy compared with many other countries. (Disclosure – I’m from New Zealand).

  47. #47 K
    May 27, 2009

    I’ve lived in the US (in one northeastern state) and UK. I’ve seen unhelpful and even incompetent docs working in both systems. I’ve seen people’s acute illnesses mismanaged and even death by negligence in both systems. I’ve seen care vary wildly within the same systems. I’ve seen hospitals so filthy I wanted to retch, and hospitals so clean and orderly that bacteria just wouldn’t dare to try sneaking in, in both systems. I’ve seen health care providers worth their weight in gold, and health care providers I’d like to see booted permanently out of their jobs, in both systems.

    The employer-provided health care package we had in the US got more expensive every year, and every year more conditions were placed upon it; it was the incredible shrinking insurance plan. In the UK, we don’t have to worry about whether it’s worth our while getting a dental plan or a mental health plan for higher premiums just in case we developed problems.

    In fact, when we moved back to the UK, I was shocked at how constantly the NHS is rubbished. Yes, there are changes that need to occur – mostly as a result of the forced privatisation by stealth imposed by Thatcher, which added layers of management and bureaucracy, forced NHS hospitals to accept the block booking of their hospital facilities for use of private health care groups (i.e. an NHS patient may not be able to access an MRI when they need it because the hospital has been forced to book timeslots for private patients, whether those slots are used or not), etc. Worse, who mops up when private medicine goes horribly wrong? You’ve got it: the NHS repairs botched surgeries and treats those whose private doctors screwed up their medication.

    But we in Britain have become used to expecting free health care, and we have forgotten why we so desperately needed the NHS in the first place. Familiarity has bred contempt, fostered by the Thatcherite credo of capitalism at all costs (“There is no such thing as society”), short-term self-interest above all else.

    There’s stuff that needs changing about the NHS. But none of it is about it being a universal health care system. All of it is about politics, about dysfunctional systems put in place by people whose goal was to “starve the beast” (i.e. destroy public services). And while a couple of my family members have experience very poor care for their acute conditions in a couple of hospitals, overall the whingeing you’ll hear from Britons about the NHS is rooted in a culture in which rampant cynicism and complaint about public services has been fostered for 30 years (keep ‘em moaning, and keep ‘em compliant).

  48. #48 dantel modelleri
    May 27, 2009

    Thank you for the summary we are going some dantel modelleri for some one its really good…

  49. #49 RossM
    May 27, 2009

    Further to my earlier post – I am pretty sure the US state spending data I refer to was from a McKinsey and Company article. McKinsey has some good economic data at http://www.mckinsey.com/mgi/publications/healthcare/slideshow/interactive.asp

  50. #50 Jim Ward
    May 29, 2009

    Before we try to implement changes I think we need to look at why costs are so high. Just saying “we need a universal system” without looking at why things aren’t working currently might only lead to another system that doesn’t work. Some of the reasons I’ve heard of higher expenses are:

    1) Liability/malpractice insurance
    2) Doctor’s prescribing unecessary tests
    3) Hight cost of prescription drugs
    4) Administrative inneficiencies/administrative burden
    5) Mistakes

    Any I’m sure there are more. We need to look at how to rein in those costs and the best solution to do so. That might be possible under a free market system as well as a universal system. At this point I just don’t know if you can say a universal system will “fix it”. We need to look at the real reasons why other countries have lower costs. You can’t say country “x” has lower costs therefore their system is better and we should use that. The goals here should be converage for all at lower costs while still providing high quality service and we should use the best way to get us there.

  51. #51 Carolyn
    June 5, 2009

    I kow this is a late comment, but I think that the > 6 months wait time comparison between Canada and the US is misleading.

    Some years ago, when my mother had a hip replacement, she was part of a study about hip replacement outcomes in multiple centres in Canada and the US. They sent her the report at the end. The patients in the UC centres had less long waits, on average, but on average they were older and had more advanced arthritis. The study reported that for most of them, their insurance required them to wait for the arthritis to progress before they approved the surgery, wheras in Canada, given the wait times, surgery would be suggested earlier.

    It doesn’t make the wait times great, for sure. They’re too long here, everyone would agree. But it means the comparison isn’t easy.

    I can’t easily find the article from the study, alas. Things might also have changed, I know.

  52. #52 slpage
    June 15, 2009

    “You have omitted how much people pay in taxes for these entitlements”

    Have you considered how much we pay NOW for the uninsured? Do you think that if a homeless person goes into the ER and receives treatment it is just free?

    It seems to me that in a “Christian” country to allow multitudes to go without adequate healthcare for apparently the sole reason of wanting to avoid even the appearance of ‘socialism’ (i.e., purely ideological purposes) is immoral.

  53. #53 frodo
    June 29, 2009

    #52, I find it amusing that you would be ok with stealing from your neighbor to pay for your health care. Government is not charity or compassion, it is force. Forcing your neighbor to pay for someones healthcare is not christian, it is theft.

  54. #54 Frieda
    June 30, 2009

    The rising cost of healthcare in the US is the fault of all participants who profit financially from it. The drug & insurance companies who have had a strong pull in congress for many, many years. The litigation lawyers who prey upon poor people and like to play the “blame game” when procedures don’t fix things they way they think they should. The physicians and hospitals who order extra and unnecessary tests and procedures when they know someone has insurance. Also, padding the bill (charging $10.00 for one tylenol for example) to cover the cost of uninsured patients. I could go on and on.

    As far as medicare is concerned, the program was started in 1965 and is the accumulation of money from every employed person in the US who has paid into it since then. It was supposed to be used for them after they retired. With that many contributions, there is no good reason for medicare to fail, accept for mis-management. A large reason that could happen is because our own government has been “borrowing” from it to cover it’s own overspending thoughout the years. Government has also allowed other supposedly “qualified” people to have benefits. These people usually have worked very little, or not at all, but can still tap into the system because of their age or because they are a dependent child of a deceased recipient.

    So, which is better? Private healthcare which seems only exists to make a profit? Or, government-run healthcare which will probably result in higher taxes and improper managmenet?

    Either way, I am afraid the citizens of this country will be on the losing end.

  55. #55 LanceR, JSG
    June 30, 2009

    Government is not charity or compassion, it is force. Forcing your neighbor to pay for someones healthcare is not christian, it is theft.

    Horsefeathers. We are a society. We, as a society, decide to use our combined resources to provide certain services. If we, as a society, decide that healthcare should be one of those services, it is not theft anymore than universal policing is theft. If you choose not to support society, you are more than welcome to leave.

  56. #56 Ed
    July 2, 2009

    53: “I find it amusing that you would be ok with stealing from your neighbor to pay for your health care. Government is not charity or compassion, it is force.”

    Yeah, I remember when I read my first Ayn Rand book.
    (I must have been about 18 years old; god, I was an insufferable little turd for about a year there. Good thing I snapped out of it.)

  57. #57 Drew L
    July 5, 2009

    #52, I find it amusing that you would be ok with stealing from your neighbor to pay for your health care. Government is not charity or compassion, it is force. Forcing your neighbor to pay for someones healthcare is not christian, it is theft.

    Isn’t it odd that compassion must be forced on Christians?

    May I suggest reading 1st John 3:17
    – If you don’t have your Bible handy it reads thus:

    “But whoso hath this world’s good, and seeth his brother have need, and shutteth up his bowels of compassion from him, how dwelleth the love of God in him? ”

  58. #58 Mary Lochner
    July 9, 2009

    You will lose the healthcare debate if you insist on making your point near the bottom of the story. You lost more than half your audience by the time you finally got to it. For goodness sake, hit ‘em with the point first and then follow it up with data. You’re not going to be losing your audience because your argument isn’t sound; you’ll lose them because it’s poorly organized. And no, people don’t drone out your tables and figures because they’re not smart enough. They stop paying attention because hearing out another person’s argument isn’t supposed to be a guessing game. You’ve got great information and great arguments, and they are becoming waste communication in the hands of most readers because you’re offering them through an ineffective structure.

    The following should have been much higher in the story:

    “…the data suggests more people around the world in these systems experience less of these problems than those of us in the US. We spend more, almost twice as much as any other country. Despite that, our wait times for physicians are worse, we pay far more out of pocket for prescriptions and copays than any other system, we spend more on administration of health care than any other country, we have more people who avoid seeing the doctor for fear of costs, and we are more likely to say we want our system scrapped.”

    Please keep up the great work — but your delivery needs improvement!

    Thank you,

    Mary

  59. #59 Jim
    August 28, 2009

    Americans who are pro universal health care sure do like to stretch the truth of what Canadian health covers, and make it sound like it’s the greatest thing since sliced bread. It is far far from it.

    I noticed for example, the MYTH where its claimed prescription drugs are “heavily subsidized”. They are not heavily subsidized. They are slightly subsidized,and that depends on the drug.

    More accurately, SOME drugs are subsidized. While some drugs do cost less in Canada, others don’t. Furthermore, large numbers of Canadians come to the United States to buy drugs because so many drugs are not available at any cost in Canada.
    The Canadian government purposely restricts the overall availability of prescription drugs through a combination of a lengthy drug approval process and oppressive price controls. The result is that patients are often harmed instead of helped.

    From 1994 through 1998 the federal government considered some 400 drugs, but ruled that only 24 – or 6 percent – were substantial improvements over their predecessors. Many drugs never win federal approval and cannot be purchased in Canada.

    Even if a drug wins federal approval, it faces 10 more hurdles – the 10 provinces. Each province has a review committee that must approve the drug for its formulary. Of 99 new drugs approved by the federal government in 1998 and 1999, only 25 were listed on the Ontario formulary.

    In theory, Canadians whose drug purchases are not subsidized can buy any drug that has federal approval even if it does not have provincial approval. In practice, drug companies often don’t market those drugs widely because the demand is likely to be so low, thus limiting availability still further.

    While keeping some prescription drug prices down through price controls, Canada has been unable to control overall drug costs. OECD statistics reveal that when the PMPRB (Patented Medicines Price Review Board) was created in 1988, per capita expenditures on prescription drugs was $106; by 1996 that had doubled to $211 per person. A study of international drug price comparisons by Prof. Patricia Danzon of the Wharton School of the University of Pennsylvania concluded that, on the average, drug prices in Canada were higher than those in the United States. Some individual drugs cost far more in Canada. For example, the anti-hypertensive drug atenolol is four times more expensive in Canada than in the United States.

    Some provinces also subsidize drug costs for low income people, which is helpful is some cases, but not in others.
    All provinces require that chemically identical and cheaper generic drugs be substituted for more expensive brand-name drugs when they are available. However, British Columbia has gone farther with a “reference price system.” Under this system, the government can require that a patient receiving a drug subsidy be treated with whichever costs the least: (a) a generic substitute, (b) a drug with similar but not identical active ingredients or (c) a completely different compound deemed to have the same therapeutic effect. Patients are often forced to switch medicines, sometimes in mid-treatment, when the reference price system mandates a change.

    Twenty-seven percent of physicians in British Columbia report that they have had to admit patients to the emergency room or hospital as a result of the mandated switching of medicines.

    Sixty-eight percent report confusion or uncertainty by cardiovascular or hypertension patients, and 60 percent have seen patients’ conditions worsen or their symptoms accelerate due to mandated switching.

    Also, things like physiotherapy are NOT covered, nor are eye exams and eyeglasses, foot care, chiropractic services,
    medical devices such as crutches and wheelchairs, anything other than plaster casts.

    Also NOT covered is dental care, not one bit of it. Nor are lost wages or income covered should you have a lengthy illness.

    Canada’s health care is only a BASIC coverage system, and worse, NONE of what is covered under the Canada health care act can be provided by private health clinics. They can however provide services not covered under the Canadian health care system, or any services covered but not available (and there are many) which is why we see a lot of Canadians coming across the border for medical services that are either not provided, or not available in a timely manner, or a little of both.

    We already HAVE medicaid, and medicare for seniors which is very similar to Canada’s universal health care, in fact superior because we have all services available in the USA thanks to private insurance.

    It makes absolutely no sense at all to destroy private insurance industry, and forcing everyone onto a limited, rationed services system.

    All that is required is that services such as medicare and medicaid be fixed, the fraud and abuse eliminated, and make it work for those who cannot afford their own private insurance.

    For private insurance, there are many things we can do to make and keep it affordable for everyone else. tort reform, streamlining administration, forcing unconditional coverage, establishing a capped fee structure for example.

    Overall, private health care in the USA is CHEAPER than what the average working Canadian pays for limited universal health care through their taxes, plus our private health care covers EVERYTHING, including lost wages and dental care.

    We need to be very carefull what we wish for, because we just might get it. And once we destroy the private insurance industry (and millions of jobs along with it) we won’t be able to get it back.

  60. #60 David
    August 31, 2009

    Thought provoking comments all around. Below is the URL to a website with some articles on the Canadian health care system, written by a Canadian.

    http://www.themorethingschange.weebly.com

    There are some good points made on both sides of the issue.

  61. #61 Diane
    September 5, 2009

    Dear Jim,
    What in the world are you talking about? “…our private health care covers everything, including lost wages and dental care.” In 30 years of employment, I never had a health care policy that paid for lost wages and the dental care was non-existent or extremely limited. Three years ago when I became seriously ill then permanently disabled, there was no money for living expenses from any health care policy for the months I was laid up after surgery. Ordinary living and paying for Cobra coverage has almost wiped out my retirement fund – $36,000 for Cobra then conversion insurance. I still have another year before Medicare kicks in and that $1000 a month insurance plus copays ($40 regular doctor visits, $300 emergency room, $300 cat scan or MRI, $300 a month in prescription copays) will wipe out the rest. Like most people, I worked and lived and planned on retiring at 65. At the age of 50, I was struck down with a disease of which there is no recovery, just management. Being of average earnings, there was no way to plan for it as extra insurance was beyond my means. I just think that most people who fight universal health care are clueless. Unless you have millions saved or an employer who actually pays for extra temporary/permanent disability insurance, you are one chronic disease away from the poverty I live in. The average American isn’t prepared. I paid my taxes and my dues for 30 years and my country has deserted me. Give me a ticket and citizenship in a country like Norway or Australia and I would gladly leave. I have grown weary of eating bread and generic corn flakes everyday.

  62. #62 pat
    September 10, 2009

    The USA has the highest life expectancy in the world when homicides and car accidents are factored out across the board.

    If you want to blame our health care system for homicides and car accidents, go ahead, but you can’t say that we spend mroe and get less unless you’re a simpleton.

  63. #63 Monica
    September 26, 2009

    In this case I believe the presentation of data before making the point is exactly what needed to be done. Not only should scientific conclusions be based on the data, but this issue is so polarized that many people wouldn’t read the data if they knew ahead that it didn’t support the conclusion they have previously formed, thus having no ability to persude.

  64. #64 daniel
    September 27, 2009

    Unless you can answer that and stop the rot, you’ll have the same problems regardless of having universal health care or not.

  65. #65 Gary Goodman
    October 25, 2009

    “…our private health care covers everything, including lost wages and dental care.”

    I HATE when people resort to telling bald-faced lies to win a point.

    As Diane pointed out, standard health care does NOT cover optical or dental, dental is a luxury, and that is rare or non-existent. Eye injuries or life-threatening dental emergencies *might* be covered. Then again, even that might be “the old days”, depending on the plan.

    One report notes that current trends are from $13,000 annual medical insurance towards an estimated $30,000 annual costs just for coverage, plus copays.

    The tendency is for standard insurance to cover NOTHING, to find or invent some loophole to deny deny deny.

    Of course private insurers do not deny care to *every* sick person the moment they get ill, so quite a few people — particularly if in group plans — remain covered, or partly so, or at least for a time.

    Private insurers also increasingly sell policies with huge out-of-pocket deductables and copays that lead to years of debt repayments for a serious condition. The result is that *normal* expenses of routine care below a high trigger point are *still* paid for out of pocket, while the customer pays steep premiums for what insurance coverage is “affordable”, i.e. catastrophic coverage only.

    Minor medical emergencies are usually covered, but not always, and diagnoses of long-term medical conditions are a trigger to cancellation. (I know a family that has had long term care issues, Type 1 diabetes, Crohns, and asthma, and they are still covered … so far … this seems to refute the point of non-coverage, but it’s anecdotal.)

    Of course, if a person gets sick such that they cannot work, the insurance they need to get well is immediately threatened or cancelled due to lack of income.

    It’s as though the idea of insurance is trending towards a mirage, there when you don’t need it, not there when you do, or a parachute with more and bigger holes, a life raft with more and bigger leaks, a luxury of privilege.

    OF COURSE private insurance wants Medicare for the elderly. Do you think they want to insure that demographic? At what cost? It’s a “dead” demographic. No, they prefer to dump it. Like nuclear energy, government is the insurer of last resort.

    I agree with the criticisms of “last days care”, the gouging by Pharma (when their R & D is often sponsored by public spending), the AMA and licensing requirements that restrain competition (some vets and medics maybe could cross-train for simple procedures or even ER).

    LAWS that block free market access by consumers for cheaper drugs and stifle competition tell a stark story of priorities and hypocrisy, in an era when “free trade” is the mantra for everything, including dismantling Glass-Stegal and de-regulating derivatives/commodities/speculation. Everything Chomsky et al. have written about corporate welfare glares at you with bolding and highlighting.

    Especially in the US, there is a strong resemblance between the sanctioned gouging by military contractors with no-bid cost-plus contracts like KBR, and the sweetheart corporate welfare deal that the US government tends towards with various Medical “reforms”.

    Millions of poor and average people (70-90%) do not have the clout of a few hundred or a few thousand wealthy benefactors and lobbyists, in a Capitalist-Plutocratic Republic.

  66. #66 Gary Goodman
    October 25, 2009

    “…our private health care covers everything, including lost wages and dental care.”

    I HATE when people resort to telling bald-faced lies to win a point.

    As Diane pointed out, standard health care does NOT cover optical or dental, dental is a luxury, and that is rare or non-existent. Eye injuries or life-threatening dental emergencies *might* be covered. Then again, even that might be “the old days”, depending on the plan.

    One report notes that current trends are from $13,000 annual medical insurance towards an estimated $30,000 annual costs just for coverage, plus copays.

    The tendency is for standard insurance to cover NOTHING, to find or invent some loophole to deny deny deny.

    Of course private insurers do not deny care to *every* sick person the moment they get ill, so quite a few people — particularly if in group plans — remain covered, or partly so, or at least for a time.

    Private insurers also increasingly sell policies with huge out-of-pocket deductables and copays that lead to years of debt repayments for a serious condition. The result is that *normal* expenses of routine care below a high trigger point are *still* paid for out of pocket, while the customer pays steep premiums for what insurance coverage is “affordable”, i.e. catastrophic coverage only.

    Minor medical emergencies are usually covered, but not always, and diagnoses of long-term medical conditions are a trigger to cancellation. (I know a family that has had long term care issues, Type 1 diabetes, Crohns, and asthma, and they are still covered … so far … this seems to refute the point of non-coverage, but it’s anecdotal.)

    Of course, if a person gets sick such that they cannot work, the insurance they need to get well is immediately threatened or cancelled due to lack of income.

    It’s as though the idea of insurance is trending towards a mirage, there when you don’t need it, not there when you do, or a parachute with more and bigger holes, a life raft with more and bigger leaks, a luxury of privilege.

    OF COURSE private insurance wants Medicare for the elderly. Do you think they want to insure that demographic? At what cost? It’s a “dead” demographic. No, they prefer to dump it. Like nuclear energy, government is the insurer of last resort.

    I agree with the criticisms of “last days care”, the gouging by Pharma (when their R & D is often sponsored by public spending), the AMA and licensing requirements that restrain competition (some vets and medics maybe could cross-train for simple procedures or even ER).

    LAWS that block free market access by consumers for cheaper drugs and stifle competition tell a stark story of priorities and hypocrisy, in an era when “free trade” is the mantra for everything, including dismantling Glass-Stegal and de-regulating derivatives/commodities/speculation. Everything Chomsky et al. have written about corporate welfare glares at you with bolding and highlighting.

    Especially in the US, there is a strong resemblance between the sanctioned gouging by military contractors with no-bid cost-plus contracts like KBR, and the sweetheart corporate welfare deal that the US government tends towards with various Medical “reforms”.

    Millions of poor and average people (70-90%) do not have the clout of a few hundred or a few thousand wealthy benefactors and lobbyists, in a Capitalist-Plutocratic Republic.

  67. #67 Elaine Balliet
    February 22, 2010

    For those of you who think that you might agree with the trend towards socialized medicine in the U.S. and Obama’s and the government’s hands in the health care pot, here are some facts that you might like to research before you head down to the polls to vote for Obama again:

    1. Any time that the government is involved in our business at a personal level is bad news, and is not what our founding fathers had in mind when they drafted the Constitution, a government “for and by the people.” Although the health care system in our country does need some help, it doesn’t need the kind of help which Obama offers, as seen in my examples below. Government hands in the honey pot of the peoples’ health care is bad, bad news.

    2. Take a look at the polls, numbers which are increasing against socialized health care every day- President Obama, people don’t want your single payor health care, along with the rationing and poor quality of care which socialism involves. Here are just a few examples for those of you still “on the fence”:

    3. In the United Kingdom, breast cancer kills 46% of those diagnosed with it. In the United States, this number is only 25%.

    4. In the United Kingdom, prostrate cancer is fatal to 57% of those diagnosed with it. In the United States, this number is only 19%. Wondering why? See below:

    5. Waits are lengthy, as evidenced also in Canada- in 2008, the average Canadian waited 17.3 weeks from the time his General Practitioner referred him to when he or she actually received treatment. 17.3 weeks? This is over 4 months of wait time, people! Is this what you would like to see for the United States?!

    6. Average wait time for an M.R.I. exam in Canada is 9.7 weeks. Over 2 months? Really? When I schedueled my M.R.I. this year, my wait was nonexistent, I was seen that week.

    7. Would you like to be referred to a neurosurgeon in Canada? You might want to give up the idea completely, as the average wait time is 31.7 weeks. Almost 9 months? Really?

    8. Having problems with your foot or feet? Get ready to wait, because you’ll have an average wait of 9 months until you’re seen.

    These are just a few examples for those of you who still might believe that “Obamacare” is good for the United States. There is nothing good about it, unless you applaud higher waits and death rates, along with reduced quality of care, or none at all, depending on your age.

    Wake up and smell the honey, before it’s too late. This is the United States.

  68. #68 la jiao shou shen
    June 9, 2010

    acizler neden bizi takip eder bilmem

  69. #69 George Kimball
    May 21, 2011

    Private insurance in the US basically does not exist now (response to BillDee, #25) because of dumb laws that make it impractical for an insurance company to offer it.

    –Premiums are paid with aftertax dollars; employer based insurance comes from pre-tax dollars. The cost disadvantage for private insurance is huge – like 50% for typical taxpayers. No one is going to sell into such a market – and almost no one does.

    –There are laws that prevent interstate sales of private policies. Reduced competition means higher cost, big time.

    –The employer based system isn’t really ‘private’ because the choices available to consumers are so limited, like once a year having the option of changing to another plan – if there is another at your employer.

    The plain reality is that no customer is going to be well served unless s/he controls the purse strings. Any plan that does not have consumer choice and control at the seat of power will not serve consumers.

  70. #70 Dentist Melbourne
    March 18, 2012

    “Australia has a public baseline access to physicians with subsidization of private insurance and option of private care, prescription drugs are heavily subsidized”… it makes it sound alot better which it probably is but here in Aus we have our own issues… many prescription drugs are not subsidised and private health insurance is increasing at an alarming rate… Great article though – we are still ‘the luck country’, however, as mentioned the Netherlands are streets ahead.

  71. #71 G.Shelley
    March 23, 2012

    @67
    There is no trend towards socialised medicine in the US.
    Assuming the rest of your post was as paranoid and dishonest, I see no reason to even bother to look up the claims to refute them, other than the prostate cancer and breast cancer statistics, which I already know to be an artefact of excess diagnosis in the US, and which has nothing to do with who pays and how treatment or diagnosis is funded

  72. #72 Scott Morris
    April 5, 2012

    @Elaine Balliet – You do not cite any source for your numbers, and you are citing only two specific diseases. This is not a sound methodology, nor presentation of facts. Secondly, your assertions make the very same limited-view mistake (or perhaps not a mistake) that is most common. You are comparing the US system where more than 40 Million people are not covered, and will not get treatment, to a system where everyone gets treatment. You cannot statistically compare those two samples at all, much less when picking only two particular conditions. What about average life span, infant mortality, overall deaths due to cancer (as opposed to just one or two types)? Not to mention preventive care or other aspects of the overall healthcare picture. If you think that you won’t wait as long to see a neurosurgeon or other specialist in the USA, guess again. How long do you think you have to wait if you are uninsured? I think “FOREVER” is longer than any time you mentioned.

    I was in an emergency room not long ago for a nearly severed fingertip. I waited over 9 hours. I was not seen by a doctor, but by a practicioner who said that it had been than been too long a time period to stitch my finger. I was given a wound cleaning and steri strips. My bill was right around $1000.

    As for wait times, even with coverage now, I have yet to get a doctors appointment within 10 days at any given point.

    Also consider, if you don’t have health coverage, no neurosurgeon (or orthopedist…etc) is going to see you. Yes, they are required to treat you in an emergency room. But they are only required to stabilize you. Once you get referred to an outside specialist, good luck getting anyone to see you. they are not obligated to treat you. I speak from direct experience. Additionally, I can cite numerous examples of people who cannot change jobs or start their own business because of health coverage. I know still others who have not been given raises on par with their peers, despite glowing job performance, and they happen to have family members with extraordinary health costs.

    Finally, “Obamacare” as it is commonly called IS NOT A SINGLE PAYER SYSTEM. In fact, there is no government coverage outside of the very poor being included in Medicaid. Your post is precisely what this article is about – misinformation and ignorance.

    Free market dynamics and health care simply do not mix. What we have is a product of that, and it is terrible. The lack of coverage inhibits opportunity and pursuit of hapiness for many millions of Americans. The problem is, the ones who are covered, just don’t give a crap. The American way of the common person is to only give a hoot about yourself.

    Secondly, you contradict yourself and also make the mistake that many people seem to make in characterizing the government as a separate entity from the people. We elect our leaders. Our government is the people, by it’s very nature. So if the government is of the people, by the people and for the people, how can bigger government be inherently bad? The problem is, we elect leaders that have personal interests at hand instead of representing the people. We need leaders in this country dedicated to truly informing the people and representing their constituents over their own personal beliefs.

    Personally, if I have to make a choice between someone deciding about my care and maintaining my personal information, I would rather have the government doing it than a private corporation. After all, I have no say in how that corporation is run. They don’t give a crap about me. They care about the stockholder. Their job is not to care for me and my family, but to reap the largest possible profit for the stockholder. This creates a system that by its very nature, is designed to bring in more dollars than it pays out. When was the last time you heard of a health insurance company going out of business?

    If my government is running healthcare, and the government is of the people by the people and for the people, then its sole healthcare mission will be to provide the best possible care to those people. If I don’t like how it is being done, I have my vote and my voice. So you think an insurance company is going to give a crap what I have to say? Of course not. The system sucks at its very core.

    The point of the article is to show factual data that shows the single-payer systems (and variants thereof) are no worse, or very close to what we have in the USA. But our system has 40 Million people without coverage, who’s freedom and liberty are stunted as a result, and we still spend 5 times more public money on healthcare than the other countries.

    Clearly, this great system you seem to think is quite grand, is indeed not. Again, the system sucks at its very core. Corporate profit and healthcare need to be divorced entirely, and the healthcare systme placed in the hands of the people, not the corporations. This can be said for much of America. After all, as you said yourself…our government is one of the people, by the people, for the people…right?

    Also, you must not ignore the part of the constitution that also says that our government must “provide for the general welfare” of the people as well. If healthcare does not qualify as general welfare, nothing does.

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