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Sick around the world
Thursday, November 12, 2009
PBS reran this 2008 Frontline documentary the other day that looked at health care systems in other developed countries around the world and, if you're interested in seeing how we compare, it's well worth 50 minutes of your time.
The fact that personal bankruptcy due to unpaid medical bills is virtually unheard of in the entire developed world except for the U.S. is, in itself, very telling.
11 comments:
The other thing that I came away with was that practicing medicine in the rest of the Western world is not viewed as a profession where you'll get rich.
Yeah, Frontline is who you go to for unbiased analysis.
One would hope someone into economics would understand that a system doesn't operate in a vaccum. Universal healthcare comes at a price. That price may be a lower overall standard of living, unavailability of some services, and a lack of choice. Get a Dr who doesn't get it? Tough, you've had your chance. Next please!
I don't doubt they have fewer bankruptcies due to healthcare. They also happen to live in homes that are smaller, drive lower performance vehicles, until recently had unemployment double our rate, and enjoy a lower standard of living in general.
Our current system sucks. People lose coverage and get screwed. People get sick and get screwed. But the problem isn't lack of govn't intervention. It is:
1. Linking health insurance to employment. Lose your job, lose your coverage. Self-employed or unemployed, no tax break for buying your own.
2. Limiting coverage to state cartels instead of allowing insurers to cover patients nationwide. This inhibits competition and raises rates.
3. Requiring insurers to cover items many don't want or need (pregancy coverage, drug addiction coverage, mental health coverage, etc) which drives the cost up.
4. We cover routine expenses, violating the main theory that insurance is for UNFORSEEN occurances. Currently our health insurance is partially a health pre-payment plan, not insurance. We want to go to the Dr for a cold and pay $10. That is reflected in the premium.
5. Involving insurance in every tiny proceedure drives the cost up, due to lack of competition, administration cost, etc.
6. Gross inefficiences in the way servies are provided. That is an industry problem.
7. 50% of healthcare costs for an individual are expended in the last 6 months of life. Want to live forever? It'll cost ya. We can keep people alive today who would have died 50 years ago. That costs money, sorry. Nationalized plans may not always do this. Money IS an object for them.
8. We turned our expensive emergency room system into a welfare routine care system. This is an obscenely expensive way to treat sore throats and headaches.
The idea that anything is "free" would be ignorant. And the idea that government provided anything won't double the cost is equally foolish.
I recently had to get my own insurance due to a job loss by my spouse (I'm self employed). I was 45, the wife is 37. We both have prexisting conditons (arthritis, high bp, knee surgeries, family histories of cancer and heart disease, etc) . We paid a whopping $450 a month for the both of us with a $2500 ded. with a major insurer. Cry me a river. TANSTAAFL. $15/day to insure against financial disaster.
Want more jobs to flee the country for the 3rd world? Go ahead and nationalize it. meanwhile, those "uninsured" young people who voted democrat spend more on their iphone bills each month than a comprehensive policy would cost them in their 20's. Kaiser Permanente, $90/month for a 21 y/o. Boo hoo. Maybe you can buy a few less drinks at the bar this weekend.
Yeah, two choices.
1) A true free market approach so that competition keeps costs reasonable.
2) Public health coverage, so gov can mandate affordable prices.
The current system of de jure monopoly is unaffordable for the country. Twice as much per capita as Euro spends is too much, especially when debt to GDP is already off the charts. Small businesses employ 40% of the private work force, and they are dropping coverage rapidly. Even the big corps are declaring bankruptcy to get out of providing retiree coverage. The current cost spiral is unacceptable. Many private individual policies start out reasonable, but then go up at double digit rates. After a few years, the healthy apply for new policies, and the rest cannot afford the premiums any more.
The legal profession is sucking us dry.
Anonymous at 2:06 PM, did you even watch the Frontline episode? I am 47 and have lived overseas. I've experienced both the educational and health care systems in what you would probably call "socialist" countries that are actually quite a bit more free in every way than the good ol' USA. The untried ignorant "free market" solutions you red state talk radio goons throw out for every problem have ceased to be even amusing. It's a good thing that mass stupidity of you and your ilk has resulted in a job loss for your spouse. It's just too bad that we can't design a system that would leave you and your ilk uninsured while providing the rest of us health care so that you could suffer your arthritis and cancerous death alone.
Anon 7:53pm -- thank you. I also don't get why we can't just basically copy a system of a country which clearly does a much better job with healthcare, say France. (OK, I get it - doctors and drug companies would make less money and insurance administrators would be eliminated, so they get screaming heads telling idiots stories about how Steven Hawking would be dead now had he been born in the UK...)
Market works wonderfully for distributing cars and TVs -- you get what you what you pay for. I don't want to leave in a society where you get the medical outcome you pay for -- poor kid dies, rich kid lives.
The US system is designed to deliver financial well-being to the health care workers. It works. There are lots of players, lots of businesses, each looking for maximum pay, revenue and profit. Private health care does deliver excellent health care for the money. Yes the money is high but lots of specialists need to get paid the big bucks to fix the sick. And yes, 50 millions got priced out of the market, because they can afford no insurance. But that's the nature of all private sector businesses.
Other countries have decided, many decades ago, that health care as for-profit business is not what they wanted. So they implemented different systems but all based on availability to all citizens, financed by state money. Just like the police, the fire fighter, air traffic controllers, the military and what's not.
Either you go private and accept its good and bad. Or go public and accept its good and bad as well. There is no in-between.
Other countries are pretty happy with their systems, because once they decided they simply made it to work that way.
It's the US that is facing a 'problem'. But that 'problem' is a fundamental feature of private system. No point arguing about it, or attacking other systems.
«I don't want to leave in a society where you get the medical outcome you pay for -- poor kid dies, rich kid lives.»
Then you should move to a tyrannical soviet hellhole like Canada or England, because it is well established that in the USA Real Americans think that losers should LOSE, and good riddance to the exploitative, parasitical poor kids who want to STEAL THE PROPERTY of productive, creative rich kids to pay for their own undeserved healthcare.
Real Americans want social justice and to protect the right of productive, creative workers like Cayne or Fuld to their hard earned pay, without it being confiscated at gunpoint by a far left extremist government to fund Communist healthcare to the benefit of minorities of lazy, fat exploitative parasites who don't want to work and pay their own way, not even to pay for their own children's health expenses.
In Real America people take personal responsibility, and if they don't generate enough value to contribute to society for what they wish to consume, be it food or health care, the consequences are theirs alone.
Now are there many Real Americans out there? Well, I am not a Real American and have a very different outlook, but consider that Hillarycare was defeated by property owners terrified of being expropriated to the benefit of malicious minorities, and consider one current comment by a Real American:
http://blog.mises.org/archives/011021.asp#c625095
«For the moment I have health care. I am a responsible American. I have an HSA. I am paying for the health care I need through a voluntary exchange of payment for services. If you pass ObamaCare in any form, that will end. I will shrug. I will close my HSA account. I will cancel my policy. I will NOT participate in or support ObamaCare in any way, shape, or form. I will not sign up. I will not sign my children up. I will not pay any additional taxes for it. I will not pay any fines you try to impose on me for not participating.
YOU will have to send your jack-booted thugs to my home in attempt to force my participation. In the end you will fail. I will not capitulate. I will not be caged. YOU will have to put the gun to my head and pull the trigger. If this is what YOU want then I invite YOU to my home to have the courage of your convictions, to come to my home and pull the trigger yourself. You won't. You are a coward, like every other tyrant through history you will not get your hands dirty, you will send others to do your dirty work.»
Good to see even on an alternate view web site such as this, most comments are for a socialized medical system. The times are a changin!
Yeah, I thought that was interesting too.
For decades, as foreign countries one by one adopted public health care systems, America responses were unified - "Go To Hell with your Socialized Big Bad Government System!!"
But the 'stupid' foreigners did not listen to America preaching that the superiority of free market magic can work for everything in life. Soon, America is left alone in a sea of public health care all over the world.
America cried - "All you commie dummies will fail and we will crush all you losers!" Foreigners watched and shake their heads. America deep belief in the magic of the market is so strong, it is beyond religious worship. Which is why US governments have been implementing privatization policies for decades. Because when one leaves the private sector alone wonderful things will happen.
The financial industry was left alone - just let the smartest guys in the world do their thing. Well, they have done their thing all right.
The health care industry is also left alone, except Medicare & Medicaid. And now we get to enjoy the show.
As American decades-long insults of foreigners' socialized health care became somewhat muted lately, the magic of the free market begins to reveal itself too. And this is: to maintain the financial well-being of the health care players, from physicians to malpractice lawyers, more and more people must be priced out. The math of it is well-established market economics. It is unstoppable.
So, take this to its logical conclusion, or zenith, what do we have?
100 million people will be priced out in 5 years. About 150 million in 10. Half of the US population will not be able to afford health care insurance by around 2020. [Note the curve is non-linear; it is exponential growth.]
"Market always win if undisturbed by the state" so goes the dogma of Real American. But by 2020 a funny thing can happen. When you have 150 million people who cannot afford basic health care, it is not economics or ideology anymore. It is Revolution. And I ain't talking about yet another amazing product in the TV commercial that's going to 'revolutionize' your life.
I wonder what all those 'stupid' foreigners will say to America then? Maybe 'Come on over!"
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