People keep telling me how great it would be if we had a nice, organized system of nationalized healthcare here in the US, but I've always been skeptical. I keep hearing horror stories of people dying while waiting for basic operations or even not being able to get simple tests in Canada or Germany. All of this anecdotal evidence has made me leery of the concept. Clearly I'm not alone given the extremely negative reaction to Hillary Clinton's attempt to socialize our healthcare system in the 90s. Yet people keep telling me how great it would be and how so many Americans are uninsured and don't get adequate healthcare.
It turns out that people in Europe are thinking about this issue too, but apparently they're trying to figure out why their nice, efficient socialized medical systems are killing them while our chaotic mess of a system is keeping us alive longer and getting the typical patient enormously better care much faster. I ran into a fascinating article on this subject by James Bartholomew in the current issue of Britains The Spectator. To read the whole article you have to register, but there's no cost and it's well worth the few minutes to sign up.
The genesis of the article is that Bartholomew noticed statistics showing that the death rates for the most common forms of cancer were shockingly higher in Britain than in the United States. For example, women with breast cancer in Britain have a 46% death rate as opposed to 25% in te US. Men with prostate cancer in Britain have a 57% mortality rate while in the US only 19% die and the death rate is declining rapidly because of early detection. It's the same with colon cancer. In Britain there's a 40% survival rate and in the US there's a 60% survival rate. With cancer of the esophagus only 7% survive while in the US 12% survive, although it's still one of the most deadly forms of cancer.
This pattern seems to hold true across the board. For virtually every form of cancer your chance of living is 50-100% better if you live in the US than if you live in Britain. I did some research of my own on the topic to see if Britain just had particularly bad healthcare and discovered that the statistics are similar for the socialized medical systems in the rest of Europe. While there were some variations for individual forms of cancer, the overall pattern in Germany, France and the other major European nations was that the death rate for most cancers is close to double what it is in the United States. Britain actually has some of the best survival rates in Europe for breast cancer. Get breast cancer in other European countries and you might as well just dig a hole and jump in. The same is true for colon cancer where the survival rate in most of Europe is less than 1/7 of the survival rate in the US.
Article comments
— go to most recent comments1 - RJ
Superb article!
FWIW, I'm a fairly healthy 20-something, and my health/dental/vision insurance (which I get through my employer, who obviously ships in as well) costs me more than $200.00 per month.
And it just covers me, no dependents.
FYI...
2 - RJ
"chips in" I meant...
3 - Big Time Patriot
Perhaps another perfectly valid explanation is the high price of failure in medical procedures in America. In other words, perhaps it is medical liablity lawsuits that drive the excellence of medical care in America?
Don't let the Republicans push bad medicine on America by letting doctors and hospitals do sloppy work with no penalty...
4 - Dave Nalle
Not exactly the responses I was expecting here.
First, RJ. I bet your deductible on that insurance is under $500. If you bump it up to $2000 your premium would go down enormously.
And BTP, I was going to suggest that one of the best ways to make our system work better would be to crack down on frivolous lawsuits and excessive settlements. Republicans aren't trying to let doctors off with no liability, but they have to be allowed to do their work without constant threat of meritricious suits which insurance companies settle at the doctor's expense just to brush off the plaintiff and save the company a few dollars.
Dave
5 - bhw
FWIW, I'm a fairly healthy 20-something, and my health/dental/vision insurance (which I get through my employer, who obviously ships in as well) costs me more than $200.00 per month.
THat's high for your contribution. What percentage of the premium is your company covering? And how good do you consider the coverage to be?
You can get perfectly adequate, functional health insurance for under $100 a month if you're willing to pay $50 for each doctor visit or a reasonable co-payment or have a yearly deductible of $1500 or more or a combination of some of these elements.
I can't. I checked the site, and they don't offer insurance in my state (MA), so I tried again with a NJ, figuring that the states had similiar costs of living.
The cheapest coverage for my family (2 adults under 40 and 2 kids under 7) was $650/month for an Oxford Health Plan EPO, which isn't too bad considering that the total cost of our premium is more than that now when you add up my husband's employer's contribution with ours.
But the coverage is poor by comparison.
[We're very lucky right now and have been for several years. My husband's company pays 90% of the insurance premium and has just changed to a plan that costs us $10/office visit, which is very cheap. Our co-pay for the past 6 years was $5/visit, which is outrageously low. We realize and appreciate how fortunate we have been...and still are.]
The worst deal offered was an indemnity plan from BC/BS. For $830/month, my family would be able to choose any doctor(s) we wanted (no network restrictions), but the deductible is $10K per individual or $20K for the family! Our office visit and co-insurance costs would be 50%. Christ, what a horrible plan.
Back to better plans: With co-payments of $30/visit and deductibles of $2000 and up for the family, we'd could get a plan in the $1200/month range.
But there was nothing close to $100/month for our family, not even close, even with high deductibles.
But I think the high deductibles/co-pay argument is backwards for people/families who are struggling financially. They're the ones who can't afford office visits and diagnostic tests if they have to pay a lot out of pocket to get them. They need cheap access to preventive and diagnostic care, as well as major types of care. They have the least ability to pay for anything -- insurance or services -- and yet they need the broadest (most expensive) coverage simply because they can't pay.
So that's still our biggest problem: how to make good preventive and diagnostic care available to people who can't afford high payments to offset low premiums. In their cases, no amount of shifting the money around with copayments/deductibles will help.
So, how would these vouchers you mention help?
6 - Dave Nalle
BHW:
>>I can't. I checked the site, and they don't offer insurance in my state (MA), so I tried again with a NJ, figuring that the states had similiar costs of living.
The cheapest coverage for my family (2 adults under 40 and 2 kids under 7) was $650/month for an Oxford Health Plan EPO, which isn't too bad considering that the total cost of our premium is more than that now when you add up my husband's employer's contribution with ours.
<<
$650 a month isn't too bad for a family of 4, but I did get better numbers than that. I guess it's a good thing to live in Texas. Our family breakdown is similar to yours and I found a plan at $389 a month with a high deductible, but no percentage copay (the key consideration for major medical issues) and from a legit company.
>>But there was nothing close to $100/month for our family, not even close, even with high deductibles.<<
The $100 a month I originally quoted was for a single individual and quoted based on living in Texas.
I wonder what it is about living in the Northeast that raises the cost so much? I guess this is another reason why everyone is moving down here. The combination of lower taxes, cheaper real estate, more jobs and lower insurance cost is hard to beat.
>>But I think the high deductibles/co-pay argument is backwards for people/families who are struggling financially. They're the ones who can't afford office visits and diagnostic tests if they have to pay a lot out of pocket to get them. They need cheap access to preventive and diagnostic care, as well as major types of care. They have the least ability to pay for anything -- insurance or services -- and yet they need the broadest (most expensive) coverage simply because they can't pay.<<
That's a bit of a catch-22, but the fact of the matter is that most people who have comprehensive insurance with a low deductible, like a PPO plan or an HMO go to the doctor way too much and waste resources which raises the prices for everyone. In most cases they really don't need this sort of coverage, they just think that they do. Doctor visits really aren't that expensive unless extensive testing is required, and if you're in a situation where you truly need more than x-rays then you're going to make the deductible very, very quickly. Combining a medical savings account to cover the deductible in an emergency with a high deductible insurance plan is probably the best option for young families.
>>So that's still our biggest problem: how to make good preventive and diagnostic care available to people who can't afford high payments to offset low premiums. In their cases, no amount of shifting the money around with copayments/deductibles will help.<<
One other solution is subscription medical services, where you essentially join a practice as a subscriber and get a certain amount of preventive care visits and such. Very good structure for pediatric care, and something which is becoming more common as an alternative or supplement to insurance.
>>So, how would these vouchers you mention help?<<
I'm not a big fan of the voucher idea, but it is something to consider. Everyone would get taxed at about 5% of gross income, and then everyone would get a voucher for about $2000 from the government to cover medical expenses, be they uncovered payments for a deductible, or premiums on insurance, or a medical savings account. This would offset a good part of the cost of insurance and make sure everyone had insurance, since the vouchers couldn't be used for anything else. It would be a socialized system, but one which worked through the private sector and would require minimal administration and would be relatively cheap compared to European style systems. Family vouchers would be prorated based on the number of family members, so a family of 4 would probably get about $4000 which would be enough to pay for decent basic insurance with a high deductible, or a good leg up on more fancy insurance.
Dave
7 - Dave Nalle
I got interrupted at the end of my last comment and had to wrap it up quickly.
The problem with a voucher system is that it's pure, unadulterated 100% income redistribution. The wealthy would pay more into the system than they got back. The poor would pay in little or nothing and get back the same as everyone else. We've got other systems like this already, but I'm not fond of them and neither are other fiscal conservatives. It's actually the kind of system Hillary might have ended up giving us if she hadn't been completely discredited in the process of working it out.
Dave
8 - bhw
Well, $4000 wouldn't cover decent basic insurance for my family. These vouchers would have to be prorated on the real cost of care, if they are to be effective.
Also, I've heard the argument before that people with cheap co-pays go to the doctor too much, but I've never seen anyone provide evidence of it. Have you seen a study on this?
Besides, you yourself said that doctor's visits aren't really that expensive.
If you make the co-pay high, people won't go when they need to, and then it ends up costing more in the long run when their condition needs more care than if they'd gone in the first place. The key is to make preventive care as cheap and accessible as possible to prevent a more serious illness that requires more treatment.
9 - bhw
As for the vouchers and the poor, the reality is that the poor are never going to put in as much as they get back. They simply can't. So the question for us as a society is whether or not [and to what extent] we're willing to subsidize health care for the poor, not whether or not there's a way to make the poor pay for their own care. There isn't.
10 - Dave Nalle
Actually - and don't be too horrified here - we could make the poor pay for their own medical care if we harvested their organs when they died and sold them for a profit. Not a popular concept, but hey, why not?
Dave
11 - bhw
As long as I can sell mine when I die and leave the proceeds to my family, why not?
12 - Dave Nalle
>>As long as I can sell mine when I die and leave the proceeds to my family, why not?<<
Sounds good to me. Best of luck selling it to the medical ethics nazis.
Dave
13 - bhw
I hear you. But if I don't even "own" my body, what do I own?
I guess the flip side of the argument gets back to the poor: if they have no money and they need a transplant, then they can't compete in the bidding for an organ. The selling of organs, which are given away for free now, would raise transplant costs, when we want to lower them. Would hospitals that do pro-bono transplants be able to absorb the additional cost, or would they stop doing pro-bono transplants for the poor?
So organ transplants might become available only to the people who can afford to bid on the organ, and that's not a good thing.
Of course, if we could sell our organs, then maybe more people would be willing to part with them after they're dead, which would increase the supply.
I'm too tired to figure it all out now.
14 - Dave Nalle
I have a thought. Maybe the poor could sell a kidney to get a liver. Or sell a kidney, some lung tissue and some bone marrow for a new heart. Now there's a capitalistic thought.
Dave
15 - Ayu
Probably you are right this time, Dave. I've been living in Europe for the last 2 years and I've been frightening by the socialized healthcare system. My husband, who is a native, said that it would be a miracle if somebody who got cancer could survive here.
16 - Ayu
I mean frightened, not frightening. And I have to add, there was a poll here on whether or not this kind of sytem should continue, but the majority said yes.
17 - Mike Kole
I'll never claim that the US system is perfect, but it remains telling to me that people who could take advantage of the 'free' health care in other countries so often come here for treatment. Also, that while the 'free' treatment is available, those who can afford to get private health care in Europe, do.
18 - alienboy
Dave, you silly old sod, the only reason national health services don't work properly is if they are not funded or managed properly.
There are huge variations in health service performance throughout the new Europe but the British Health Service seems to be one of the poorer ones.
Last time I used it, a simple Doctor's consultation and subsequent hospital x-ray took 4 weeks !!!
The Spanish National Health Service is apparently the 7th best in the world and is particularly good at cancer treatment.
I twisted my ankle falling off a lorry tailgate my first day in Spain. I was in and out of the hospital with leg in plaster in 45 minutes!
I have not paid a single euro for this service and completely fail to grasp the attractiveness of the American system, from a consumer point of view.
19 - bhw
Last time I used it, a simple Doctor's consultation and subsequent hospital x-ray took 4 weeks !!!
I've waited this long for specialists in the US. I don't find our service to be all that fast once you might actually have a significant problem. I can get same-day service if I have an ear infection, but beyond that, it's a long wait. At least I think 4+ weeks is a long wait.
20 - Dave Nalle
>>Dave, you silly old sod, the only reason national health services don't work properly is if they are not funded or managed properly.<<
So Germany, France, England, Canada, Sweden, Norway, etc. - none of them fund their systems properly and their all mismanaged?
>>There are huge variations in health service performance throughout the new Europe but the British Health Service seems to be one of the poorer ones.<<
Statistically the British one is the BEST one in Europe. They have less wait time, spend more per patient, and have higher survival rates for various diseases than other European systems.
>>Last time I used it, a simple Doctor's consultation and subsequent hospital x-ray took 4 weeks !!! <<
Last time I needed an x-ray it took 15 minutes. When my Dad needed a MRI recently it took a day to get him scheduled. How long do you think that would take in Spain - more than 6 months I bet.
>>I twisted my ankle falling off a lorry tailgate my first day in Spain. I was in and out of the hospital with leg in plaster in 45 minutes!<<
Emergency treatment of major sprains and broken bones is a different matter alltogether. No matter how the system works setting a bone can't be put off.
>>I have not paid a single euro for this service<<
Wow, they don't have taxes in Spain? Last I checked you're paying a cumulative tax rate of about 50% with about 15% of that going to national health.
>> and completely fail to grasp the attractiveness of the American system, from a consumer point of view.<<
Faster service at a lower cost. The system isn't perfect, but it seems to work.
Dave
21 - Dave Nalle
>>I've waited this long for specialists in the US. I don't find our service to be all that fast once you might actually have a significant problem. I can get same-day service if I have an ear infection, but beyond that, it's a long wait. At least I think 4+ weeks is a long wait.<<
Well, it's not long compared to waits in Europe, but it is very long compared to most service here in the US. How responsive your doctor is and how fast you get tests and such is largely a function of how your HMO, PPO or other service operates. If you have straight-out old style insurance without any kind of management system you get blindingly fast service and pay a very high premium for it. If you have a HMO or PPO the service is somewhat slower, but still very fast if you have a good one.
The great thing about our system is that if you don't like the level of service you're getting with one insurer or with a particular plan you can change plans within the same insurer or change insurers alltogether to get the kind of service that suits your needs best at a price you feel is right.
Dave
22 - Sydney
I think this article attempts to contextualize itself but does a poor job of it.
America can compare its health care with that of the health care systems in Europe if it likes, but the fact is that America is far richer than most of those countries combined. America's health care is and should be slightly better.
However, it is not as good a system as is working in Canada currently. It's true that wait times are significantly shorter in the U.S., but since when does this aspect constitute "good health care". It's much more complex than that.
If you were to limit health care to one factor, than surely it should be that health care should be equity. Health care should be equally accessible and available to everyone in your country. Americans love to just debate on ways they can improve public services for those that can AFFORD to pay for them. This means nothing to the people in the U.S. who can't afford healthcare. Why is it that we Americans always keep this arrogant attitude that the have-nots did something to deserve to not get the opportunities we all get. I’d gladly risk waiting in line with everyone else if it meant changing the system to be fair for everyone, not based on how much money you make.
I'll tell you right now that it doesn't matter how quickly your diagnosed with cancer in the United states, because for a lot of people its not affordable to get treated for it anyway. Where's the humanity in a private health care system?
Secondly, Canada is working on reforming and improving their health care within the socialized framework. Sure there is always wastage in a social system but it’s ethically sound and it works better than the Private system currently. If Canada could create a program that educated people to stop going into the hospital every time they had a cold, then it would be the best system in the world (if it isn't still considered the best).
23 - sydney
equity = equitable.
sorry
24 - sydney
Also, I want to clarify one point.
I'm not suggesting that a partially privatized system can't work, and mayeb even improve on teh canadian model, but one thing should be a priority regardless; If a person is dying, he/she should get full treatment regardless of his or her earnings.
It's sickning that Americans can just watch somone waste away slowly and say "ahh thats too bad you didn't get out and earn some more money."
25 - bhw
How responsive your doctor is and how fast you get tests and such is largely a function of how your HMO, PPO or other service operates.
That hasn't been my experience. With an HMO, I was able to get a referral to a specialist while I was visiting my primary care doctor. Then all I had to do was call the specialist and get the next available appointment. The calendar was pretty well booked. I saw my primary care doctor and called the specialist on the same day, but I had to wait a few weeks for an open slot. This had nothing to do with my insurance.
I've had a PPO for seven years, and even with this plan, where I don't need a referral to see a specialist, I've had to wait a few weeks. They're just busy. One specialist did a "triage" sort of scheduling, but another just gave me the first available appointment. That was a dermatologist.
I have a very good insurance plan. My ability to see specialists quickly has been affected by how busy they are, not by how quickly my insurance company acts. Of course, when I want to see a specialist, I want to see him/her THIS WEEK, which I suppose isn't very reasonable.
The great thing about our system is that if you don't like the level of service you're getting with one insurer or with a particular plan you can change plans within the same insurer or change insurers alltogether to get the kind of service that suits your needs best at a price you feel is right.
Again, my waiting time for specialists had nothing to do with my insurance. That said, my ability to switch plans is limited, if I ever wanted to do it. I can only choose from the options my husband's employer offers. We're lucky to have three to choose from. Other companies don't offer a choice.
But it's not the market of wonderful, cost-effective choices you describe it to be. If we were to eschew the insurance offered by the employer, our costs, as I found out earlier on this thread, would triple at a minimum, and that would be to receive much less coverage. To receive almost comparable coverage, it would cost us ten times as much as we personally pay right now.
That's not really an option for us.