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Healing America

I'm reading this book by T. R. Reid, on his investigation into universal health care systems around the world. I think I've seen predecessor essays online. It's interesting, and may make you want to emigrate, if you're American.

Four basic health care models:

* Bismarck: heavily regulated private insurers, often tied to employers. It's what Obamacare wants to be when it grows up into a real system. Reid compares it to our existing system of employer provided insurance, but of course there are lots of differences. Insurers take everyone, everyone gets insurance, insurance rates are set by law (note different with Romney or Obamacare), insurers are non-profit (ditto.)

* Beveridge: "socialized medicine" at its purist, doctors as salaried government employees at government hospitals. Like the UK NHS, or US VA, or in the private market, Kaiser.

* "National Health Insurance", which for some reason he doesn't call by the much snappier name of "Medicare": Single-payer, a government insurance plan paying private doctors. Like, er, Medicare. (Or Medicaid). Or Candadian Medicare. Or Australian Medicare.

* Out of pocket: yeah, you know this one.

The US is, shall we say, uniquely complex in how we provide health care. And in having competing for-profit insurers, who are allowed to spend 20% of premium money on non-health care, compared to 2-5% elsewhere. Just changing that would save a couple percentage points of GDP!

Number of medical bill bankruptcies in other developed countries: allegedly zero "and how can you even ask?" Like asking how many flying saucers land in front of the courthouse. USA is the butt of health care economist meetings and the bogeyman of health care politics fights. "Grumble grumble." "At least we're not like America. You don't want us to become like America, do you?" "Oh god, no!'"

Hey, I just realized, it's like "socialism!" in America in reverse. We say "socialism!" to shut down debate, they say "like America!" Only with more justification, given that we spend twice as much to live not as long and to not treat many curable diseases.

Supposedly 20,000 Americans die in the prime of their life every year due to treatable diseases they couldn't afford to treat. That's like 7 9/11s a year.


* France: Bismarck model. Rated #1 in the world. Only a few insurers, which you might stay with for life. France is into making you pay co-pays out of pocket unless you're destitute, even though you'll get most or all of that co-pay back from the insurer shortly; the ritual of actually paying seems to be valued. What you pay is set by the government, and there'll be a handy chart in the office telling you the prices. Contrast with the US, where the doctor may not know what something will cost. There are house calls, in fact there's extra compensation to the doctor for house calls. Everyone's covered, the "last 1%" got covered in 2000. Everyone has a smart card which contains all their medical records and facilitates electronic payments; no filing cabinets full of records, no complex or delayed payments. Go to any doctor, zip, they can see your whole medical history. Doctors make 1/3 of what US ones do (say, $60,000 for a GP), but have no college or med school loans, and pay 1/50th what US ones do in malpractice insurance premiums, while expected to never be sued. 11% of GDP.

* Germany: Origins of the Bismarck model, from the Iron Chancellor who wanted to cover workers without raising explicit taxes. (Sound familiar?) So they've been at it for 120+ years, through Kaiser, Weimar, Nazis, and postwar. After recent mergers, there are "only" 200 sickness funds, which you can shop around and change at short notice. Premiums are set by law, but what they pay doctors is negotiated with doctors' groups. You don't care, apart from a recently small quarterly co-pay you don't pay anything. They also have smart cards, though only since 2008; France beat them to it. Everyone's covered, even illegal immigrants, except for a 7% rich enough to be allowed to opt out. Otherwise similar to France, including making house calls. More doctors per capita in both countries than the US. One doctor mentions the new quarterly co-pays, and how Germans grumble, and an American quietly paid. Then, on his next visit, he tried to pay again! As if you had to pay every time you saw a doctor! Isn't that funny? 10.4% of GDP.

* Japan: Bismarck again, but I just started the chapter. Lots of advertising by the doctors. Lots and lots of doctor visits and longer stays in the hospital, but still really cheap.

See the comment count unavailable DW comments at http://mindstalk.dreamwidth.org/329204.html#comments


( 2 comments — Leave a comment )
Jul. 24th, 2012 09:05 pm (UTC)
Get this through one Republican skull, and I'll get you a Purple Heart. Get it through ten, and you will have deserved the Medal of Honour. They are armoured against debate, mainly by presuming that they are the only ones in the world who understand economics.
Jul. 31st, 2012 02:23 pm (UTC)
Which they often don't! (understand economics) Or they understand some simplistic subset convenient to their politics, having combined the ancient debate about equality with craziness about government not working at all.

I'd settle for convincing a young fence-sitter I know. Last we talked about it, she was down on UHC because of her Canadian relatives complaining about waiting lists, I think. But that was a whole college experience ago.
( 2 comments — Leave a comment )


Damien Sullivan

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