WORLD VIEW: Globalized Mythbusting
Do we have the best health system in the world? That's a complex question. A majority of Americans say the answer is ‘no,' but many are also terrified of the alternatives. Rather than let fear stifle the reform conversation, let's look at the facts -- just what are the alternatives? In The Washington Post this weekend, journalist and author T. R. Reid debunked myths about health care in the rest of the world.
We hear a lot about Canada and Britain when we talk about health care around the world. Both of these countries have national health systems where the government pays for health care through tax revenue. But most Americans don't want a single payer system, and that's not where the current health care debate is taking us. There are other ways of creating high quality, affordable health care for all Americans. All other industrialized nations have found ways to provide health care coverage for all of their citizens, for less money per person than we're currently spending covering only some Americans.
Reid points out that universal coverage doesn't mean government-run. Germany, Japan, and Switzerland are among the nations that provide health care using "private doctors, private hospitals and private insurance plans." And for all the complaining about "government-run" care, it already exists in some parts of the U.S. system -- well-liked parts such as Medicare and the Veteran's Administration health system.
Choice vs. rationing
In Germany, a citizen can sign up for any of 200 private plans, says Reid. If they don't like the plan, they can switch without having to pay more in premiums. In France and Japan, you can't pick your plan (it's assigned based on your industry or employer), but you can see any doctor or health provider you want without having to worry about "out-of-network" rates or pre-authorization -- your insurance has to pay for any doctor you choose. It's true that you have to wait for non-emergency treatment in Canada, but this isn't true everywhere. In Japan, reports Reid, waiting times are so short some patients don't even bother scheduling appointments. They just drop in on the same day.
Foreign health care systems don't practice recission, (when insurers find a way to drop a customer when they get sick). Foreign companies must accept everyone (they can't deny coverage based on "pre-existing conditions") and can't cancel if you pay your premiums, reports Reid,
The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.
Cost and innovation
Though the U.S. has some of the best educated medical professionals and most cutting-edge advanced hospitals in the world, we aren't responsible for many of today's most widespread the health care innovations. For example, hip and knee replacement surgery originated in France.
In Japan, patients see their doctor three times as often as Americans do, get twice as many MRIs and X-rays, and have longer life expectancy and higher rates of recovery from disease, reports Reid. Still, Japan spends less than half of what the U.S. spends on health care -- $3,400 vs. $7,000, per person annually. And, writes Reid,
Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)
Patchwork health care
Reid calls the American system a "crazy quilt" -- we've got a little bit of everything in our system. Native Americans and veterans have a single payer system with no bills -- like the UK. People with private, employer-provided insurance split premiums between workers and employers, like in Germany. Medicare is like the Canadian system, where people see private health providers and pay premiums to a government-run plan. For those with no insurance, we're like a third world country, reports Reid, "In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die." Hundred of thousands of Americans go into bankruptcy each year because of medical debt.
Reid says what we really need is organization in our health care system. He argues, "All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess."
So it's time to fix it. Not by copying what works for another country, but by taking advantage of this unique moment in time to create an American health care system that works for Americans. Preserving what works in our system, and fixing what doesn't in ways that reflect the values that are important to us as a nation. We can have sustainable, affordable, quality coverage for all Americans without sacrificing important American values such as innovation, fairness, and choice.
(BTW we have T.R. Reid's new book The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care and we'll let you know what we think as soon as we have a chance to read it...)