I lived in the Republic of Ireland for 15+ years. The "universal Healthcare" there was abysmal. The government run system was way overburdened with management types appointed to high paying, no show jobs on the basis of political nepotism. Emergency rooms were chaotic at best and many very ill people lay on gurneys for a week or so before a bed in a 10 person ward was available. Those who could afford it bought private health insurance (VHI being the most popular). Friends in the UK said their NHS (National health service)was nothing more than a system of triage. Elderly basically given a death sentence. I can speak for the rest of the countries but I bet they're as bad.
That's quite the thorough, unbiased analysis! Since we're talking mere anecdotes: I have a friend in England who has consistently raved about the level of health care there! I'm sure the level of care can vary at various times in various places- that said, it's still better than not being insured at all...
Coverage is not care. Show another chart for average healthcare costs per person insured. Giving "millions" access to insurance is not solving our problem of out of control hospitals and healthcare expense.
Hospitals are usually not the ones out of control- Big Pharma and health insurance companies most definitely are.
"About one quarter of health care cost is associated with administration, which is far higher than in any other country... Single-payer systems have fewer administrative needs."
Regardless of the quality of care that seems to be the topic of debate, you can rest assured that medical aid will not bankrupt you in these countries as it might in the US.
I have been severely ill 3 times in my adult days. In 2 of them I needed a major operation to get me through. Each of them cost me (in todays money) a few hundred €/$ in public hospitals. There are doctors in my family and they tell me that there is no difference in quality between private/public health care except perhaps in super difficult cases when the public has the edge. That's because only they have the money for the most advanced facilities etc.
This seems to be true in all Scandinavia except perhaps Sweden where there are very long queues right now (immigration). I'm a Finn.
Former Republican, presently a small-government Libertarian here. I'm extremely skeptical and cynical towards most of what the government does. That being said, our healthcare system before the ACA was awful, and it presently is awful.
One fact that I missed until today: despite the USA not having anything close to Universal Coverage, our government pays the 3rd most per person out of any country in the world. Including ALL costs, we spend over 17% of GDP on healthcare. France is the next highest at 11.6%, and their system is loaded with problems.
We spend a ridiculous amount more for very similar care (except cancer care; our system is actually really good there) found elsewhere for much less.
I don't know that Universal Healthcare is the answer. I'm skeptical. But I know what we had before the ACA, with the ACA, and with the current proposed Republican legislation isn't going to work.
Cash for care is the only solution. Eliminate any kind of insurance for anyone. When someone is sick or injured, the only care thye are entitled to is what they can pay for in advance.
There's an interesting story about how FDR had tried to get universal health care during the New Deal era. Insurance lobbyists, who had moved on from home/life insurance were starting to realize the gains to be made in private health insurance. They successfully lobbied to disinclude this from the New Deal.
We could have had universal health care 85 years ago. We wouldn't be in this situation now - granted, we'd have other problems, but coverage would not be one of them. Our current "let the market deal with it" approach to health care is all the result of corporate lobbying 85 years ago. This was the start of the marketization of our welfare practices (leading to our unique "workfare" welfare scheme) and a massive detour from our long progressive history prior to the Depression. The US outpaced many other nations in terms of its progressive welfare practices prior to this period.
While we're offering anecdotes, my Canadian partner's take on universal coverage is that, yeah, it's not great, in that some painful conditions are relegated to 'elective' status or are delayed in treatment for some period of time. In addition, the number of major surgeries are limited in number - i.e. you're not going to get multiple knee replacements for free.
That being said, it's rare that anyone has extreme medical costs. That's the whole point - you shouldn't be financially ruined just to stay alive. Yeah, it's less comfortable than the US, but the general good outweighs the temporary discomfort. People I've met complain about the care, but generally acknowledge it's better than having to pay for it.
I'm British but live in Japan so I've experienced two very different forms of healthcare. The UK is tough in terms of waiting for tests and non-urgent surgery but no one ever worries about the costs of healthcare. Furthermore, this means that healthcare providers across the country have to account for the costs of the service they provide — suppliers of drugs cannot arbitrarily hike their prices 2000% there. It also means that healthcare professionals do not make significant profits from sick people so there is little or no incentive to over-prescribe services. We are always able to pay for private insurance and I expect the combined cost is no more than the cost of insurance in America.
Most importantly, however, the problems with the National Health Service are not intrinsic to universal healthcare, they are happening because our current Conservative government are striving to abolish the NHS in favour of private only healthcare for the same reason as the Republican party — many of the Ministers are personally involved in private healthcare companies. This means the NHS funding is being reduced in real terms year on year in a cynical effort to make people give up on it.
In Japan, we have to pay for a third of our health costs with doctors and hospitals making money from the services they provide. The upside of this is that healthcare is generally affordable, though my personal bill would be too much for a working class family. Tests and surgery are carried out on the day or within the week, which is much faster than in the UK. On the other hand, every trip to the doctor requires a test or medicine of some sort and even minor accidents will result in a week in hospital. In other words, it's fast and efficient but results in a fair amount of wastage.
I have a PhD and my brother is a computer programmer for Boeing but we'd never have been able to reach our potential if my family had been responsible for health care. You therefore have to wonder at the incredible waste of young talent occurring in the US right now as people have to choose between health and education. And how many other Gates, Jobs, and Musks have had to give up on their start ups because of a bout of pneumonia?
I would like to point out that not all countries have full government-backed insurance. For instance, the Netherlands have a complicated mix of private insurance and government care. Private insurers mandatorily cover "insurable care", basically normal stuff: primary care, broken bones, temporary illness etc. The government sets a minimum package that insurers must cover for a maximum price. Everybody is required to have health insurance and the government will garnish your income and put you on a policy if you don't do it yourself. Competition between insurers drives that maximum price down, and insurers make money by upselling to customers: private rooms, dental, vision, physical therapy, etc. The government reimburses insurers for "uninsurable care": expensive long term disease such as cancer and elderly care. The whole system works rather seamless. My mom only paid her couple hundred bucks deductible and for her wig when she had chemo. She could call and go to a hospital 24/7 (and did).
Also, problems that non-Americans complain about may sound terrible, but are generally minimal compared to American problems. In Holland, there is a huuuuuge debate is about the size of the deductible. That's it.
When you hear people complain about waiting lists, Americans should realize that those exist mostly because of universal coverage giving so many people access to certain treatments. America has less waiting list because many people simply can't afford those treatments. Holland pretty much eliminated waiting lists by reorganizing health care a bit in the 90s. There are no more waiting lists for urgent care, and non-urgent treatment usually gets scheduled withing 3 months.
It is my observation that a lot of money can be gained by organizing care efficiently. Make sure your team of doctors knows what's going on. Schedule treatment efficiently so that medical facilities are used optimally. Prescribe generics by defaults. Allow insurers to bargain hard on pricing. The Dutch government is teaming up with the Belgian government to beat money out of Big Pharmy (long live open borders in the EU!).
I wanted to add something. In countries with universal health care extended by the government, there is more debate about health care. A good example is long-term elderly care.
In the US, there is little political debate about the level of care that elderly should receive because this is a private insurance matter, and what you get is limited by your wallet, aside from the minimal assistance provided by medicare and medicaid.
In countries where the government (partially) is involved in long-term elderly care, there is huge debate about the level of care that elderly are receiving and should be receiving. Aside from the traditional left-right politics, where the left wants more government provided care and the right wants less, it is actually a very difficult and nuanced debate to determine what level of care should be available and under what conditions. It is difficult because virtually everybody has grandparents and parents that go through the system. And everybody wants the best possible care of them. But finances are limited. And standards for decency vary largely.
Nevertheless, this debate is not very visible in the US because it is simply limited by what money can buy, and this leads to many elderly not getting the care they need.
I am Canadian, financially comfortable, and have no experience with the US system other than what I've read, but I have a lot of trouble understanding why anybody would oppose UHC.
Our system here is far from perfect, with my main issues being related to long wait times, difficulty obtaining a second opinion, and a lot of steps and delays in getting to see specialists.
That being said, I feel safe and my family is safe. If my baby gets sick, I can take him to the hospital right away instead of gambling that it is not serious.
I have insurance through my work for dental, prescriptions, and vision care, but would happily pay more taxes if it were possible to roll those into our healthcare system as well.
As was mentioned, the cost of healthcare in the United States is largely determined by insurance companies and drug manufacturers. The prices are much higher than elsewhere, and the executives earn vastly more than they do elsewhere. It's disgusting to me that people in other countries can buy the exact same medicines for a fraction of what Americans pay. And of course, these executives and companies are very active as lobbyists, and even more active as contributors to the campaigns for Senate and the House of Representatives.
This is correct, but Nepkarel's point above is also relevant: A goodly number of these countries achieve universal coverage without a single payer system. I know Germany, Belgium, Switzerland, and the Netherlands all have highly regulated insurance markets where having insurance is mandatory similar to the Obamacare model. Probably some of the others also.
Since universal coverage and single payer are frequently conflated I wanted to underline that.
I lived in the Republic of Ireland for 15+ years. The "universal Healthcare" there was abysmal. The government run system was way overburdened with management types appointed to high paying, no show jobs on the basis of political nepotism. Emergency rooms were chaotic at best and many very ill people lay on gurneys for a week or so before a bed in a 10 person ward was available. Those who could afford it bought private health insurance (VHI being the most popular). Friends in the UK said their NHS (National health service)was nothing more than a system of triage. Elderly basically given a death sentence. I can speak for the rest of the countries but I bet they're as bad.
ReplyDeleteThat's quite the thorough, unbiased analysis! Since we're talking mere anecdotes: I have a friend in England who has consistently raved about the level of health care there! I'm sure the level of care can vary at various times in various places- that said, it's still better than not being insured at all...
DeleteNo they're not. Have experience in Belgium and Austria. Still, if people can afford it... they get an extra private insurance as well.
ReplyDeleteIt seems like the best back-up plan, if you're very ill, is to drive north and don't stop until you see a Mountie.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteCoverage is not care. Show another chart for average healthcare costs per person insured. Giving "millions" access to insurance is not solving our problem of out of control hospitals and healthcare expense.
ReplyDeleteHospitals are usually not the ones out of control- Big Pharma and health insurance companies most definitely are.
Delete"About one quarter of health care cost is associated with administration, which is far higher than in any other country... Single-payer systems have fewer administrative needs."
http://www.pbs.org/newshour/rundown/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler/
Regardless of the quality of care that seems to be the topic of debate, you can rest assured that medical aid will not bankrupt you in these countries as it might in the US.
ReplyDeleteI'd like to point out the frequency of medical bankruptcy in the non-USA countries on that list as being 0.
ReplyDeleteI have been severely ill 3 times in my adult days. In 2 of them I needed a major operation to get me through. Each of them cost me (in todays money) a few hundred €/$ in public hospitals. There are doctors in my family and they tell me that there is no difference in quality between private/public health care except perhaps in super difficult cases when the public has the edge.
ReplyDeleteThat's because only they have the money for the most advanced facilities etc.
This seems to be true in all Scandinavia except perhaps Sweden where there are very long queues right now (immigration). I'm a Finn.
Former Republican, presently a small-government Libertarian here. I'm extremely skeptical and cynical towards most of what the government does. That being said, our healthcare system before the ACA was awful, and it presently is awful.
ReplyDeleteOne fact that I missed until today: despite the USA not having anything close to Universal Coverage, our government pays the 3rd most per person out of any country in the world. Including ALL costs, we spend over 17% of GDP on healthcare. France is the next highest at 11.6%, and their system is loaded with problems.
We spend a ridiculous amount more for very similar care (except cancer care; our system is actually really good there) found elsewhere for much less.
I don't know that Universal Healthcare is the answer. I'm skeptical. But I know what we had before the ACA, with the ACA, and with the current proposed Republican legislation isn't going to work.
Cash for care is the only solution. Eliminate any kind of insurance for anyone. When someone is sick or injured, the only care thye are entitled to is what they can pay for in advance.
DeleteThere's an interesting story about how FDR had tried to get universal health care during the New Deal era. Insurance lobbyists, who had moved on from home/life insurance were starting to realize the gains to be made in private health insurance. They successfully lobbied to disinclude this from the New Deal.
ReplyDeleteWe could have had universal health care 85 years ago. We wouldn't be in this situation now - granted, we'd have other problems, but coverage would not be one of them. Our current "let the market deal with it" approach to health care is all the result of corporate lobbying 85 years ago. This was the start of the marketization of our welfare practices (leading to our unique "workfare" welfare scheme) and a massive detour from our long progressive history prior to the Depression. The US outpaced many other nations in terms of its progressive welfare practices prior to this period.
While we're offering anecdotes, my Canadian partner's take on universal coverage is that, yeah, it's not great, in that some painful conditions are relegated to 'elective' status or are delayed in treatment for some period of time. In addition, the number of major surgeries are limited in number - i.e. you're not going to get multiple knee replacements for free.
That being said, it's rare that anyone has extreme medical costs. That's the whole point - you shouldn't be financially ruined just to stay alive. Yeah, it's less comfortable than the US, but the general good outweighs the temporary discomfort. People I've met complain about the care, but generally acknowledge it's better than having to pay for it.
Very good comment. Thanks, Topher.
DeleteI'm British but live in Japan so I've experienced two very different forms of healthcare. The UK is tough in terms of waiting for tests and non-urgent surgery but no one ever worries about the costs of healthcare. Furthermore, this means that healthcare providers across the country have to account for the costs of the service they provide — suppliers of drugs cannot arbitrarily hike their prices 2000% there. It also means that healthcare professionals do not make significant profits from sick people so there is little or no incentive to over-prescribe services. We are always able to pay for private insurance and I expect the combined cost is no more than the cost of insurance in America.
ReplyDeleteMost importantly, however, the problems with the National Health Service are not intrinsic to universal healthcare, they are happening because our current Conservative government are striving to abolish the NHS in favour of private only healthcare for the same reason as the Republican party — many of the Ministers are personally involved in private healthcare companies. This means the NHS funding is being reduced in real terms year on year in a cynical effort to make people give up on it.
In Japan, we have to pay for a third of our health costs with doctors and hospitals making money from the services they provide. The upside of this is that healthcare is generally affordable, though my personal bill would be too much for a working class family. Tests and surgery are carried out on the day or within the week, which is much faster than in the UK. On the other hand, every trip to the doctor requires a test or medicine of some sort and even minor accidents will result in a week in hospital. In other words, it's fast and efficient but results in a fair amount of wastage.
I have a PhD and my brother is a computer programmer for Boeing but we'd never have been able to reach our potential if my family had been responsible for health care. You therefore have to wonder at the incredible waste of young talent occurring in the US right now as people have to choose between health and education. And how many other Gates, Jobs, and Musks have had to give up on their start ups because of a bout of pneumonia?
Thank you for that detailed comment, Andrew.
DeleteIt's also worth noting that I've never met a non-American who'd prefer the American system.
ReplyDeleteI would like to point out that not all countries have full government-backed insurance. For instance, the Netherlands have a complicated mix of private insurance and government care. Private insurers mandatorily cover "insurable care", basically normal stuff: primary care, broken bones, temporary illness etc. The government sets a minimum package that insurers must cover for a maximum price. Everybody is required to have health insurance and the government will garnish your income and put you on a policy if you don't do it yourself. Competition between insurers drives that maximum price down, and insurers make money by upselling to customers: private rooms, dental, vision, physical therapy, etc. The government reimburses insurers for "uninsurable care": expensive long term disease such as cancer and elderly care. The whole system works rather seamless. My mom only paid her couple hundred bucks deductible and for her wig when she had chemo. She could call and go to a hospital 24/7 (and did).
ReplyDeleteAlso, problems that non-Americans complain about may sound terrible, but are generally minimal compared to American problems. In Holland, there is a huuuuuge debate is about the size of the deductible. That's it.
When you hear people complain about waiting lists, Americans should realize that those exist mostly because of universal coverage giving so many people access to certain treatments. America has less waiting list because many people simply can't afford those treatments. Holland pretty much eliminated waiting lists by reorganizing health care a bit in the 90s. There are no more waiting lists for urgent care, and non-urgent treatment usually gets scheduled withing 3 months.
It is my observation that a lot of money can be gained by organizing care efficiently. Make sure your team of doctors knows what's going on. Schedule treatment efficiently so that medical facilities are used optimally. Prescribe generics by defaults. Allow insurers to bargain hard on pricing. The Dutch government is teaming up with the Belgian government to beat money out of Big Pharmy (long live open borders in the EU!).
I wanted to add something. In countries with universal health care extended by the government, there is more debate about health care. A good example is long-term elderly care.
ReplyDeleteIn the US, there is little political debate about the level of care that elderly should receive because this is a private insurance matter, and what you get is limited by your wallet, aside from the minimal assistance provided by medicare and medicaid.
In countries where the government (partially) is involved in long-term elderly care, there is huge debate about the level of care that elderly are receiving and should be receiving. Aside from the traditional left-right politics, where the left wants more government provided care and the right wants less, it is actually a very difficult and nuanced debate to determine what level of care should be available and under what conditions. It is difficult because virtually everybody has grandparents and parents that go through the system. And everybody wants the best possible care of them. But finances are limited. And standards for decency vary largely.
Nevertheless, this debate is not very visible in the US because it is simply limited by what money can buy, and this leads to many elderly not getting the care they need.
I am Canadian, financially comfortable, and have no experience with the US system other than what I've read, but I have a lot of trouble understanding why anybody would oppose UHC.
ReplyDeleteOur system here is far from perfect, with my main issues being related to long wait times, difficulty obtaining a second opinion, and a lot of steps and delays in getting to see specialists.
That being said, I feel safe and my family is safe. If my baby gets sick, I can take him to the hospital right away instead of gambling that it is not serious.
I have insurance through my work for dental, prescriptions, and vision care, but would happily pay more taxes if it were possible to roll those into our healthcare system as well.
As was mentioned, the cost of healthcare in the United States is largely determined by insurance companies and drug manufacturers. The prices are much higher than elsewhere, and the executives earn vastly more than they do elsewhere. It's disgusting to me that people in other countries can buy the exact same medicines for a fraction of what Americans pay. And of course, these executives and companies are very active as lobbyists, and even more active as contributors to the campaigns for Senate and the House of Representatives.
ReplyDeleteThis is correct, but Nepkarel's point above is also relevant: A goodly number of these countries achieve universal coverage without a single payer system. I know Germany, Belgium, Switzerland, and the Netherlands all have highly regulated insurance markets where having insurance is mandatory similar to the Obamacare model. Probably some of the others also.
ReplyDeleteSince universal coverage and single payer are frequently conflated I wanted to underline that.
Ah, I found a handy map:
Deletehttp://www.worldfuturefund.org/Projects/General/singlehealthcare/singlepayermap.png