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WORLDVIEW: They Think We're Nuts

Twice in the last couple of weeks I've had conversations with non-Americans about our complex and costly health care system that leaves 46 million people uninsured. To put a highly technical spin on their conclusions: They think we're absolutely nuts.

The other night I had dinner with two German students interning at their embassy. Both were excited to be here during the early months of Obama's presidency; one had been at the Brandenburg gate when he went there as a Democratic candidate last summer. Both were pretty sophisticated, and were able to discuss some of the long-term economic challenges of rising health care costs and technology throughout the world. But as one of the young women told me, "When my grandmother got sick and her treatment cost 150,000 Euros, we didn't have to worry, it was all paid for. But I heard it wouldn't have been in America." Well, it depends. If she was 65, she'd have Medicare, which provides great coverage for some things but can leave patients with significant out of pocket costs for others. If she was younger than 65, it would depend on what kind of policy she had, what kind of services it covered, what kind of monthly, yearly or lifetime caps. And forget about it if she were one of the 46 million uninsured or 25 million underinsured. The grandmother, incidentally, is doing just fine now.

The other conversation was with an Israeli occupational therapist (a relative by marriage) who works with children with what in this country it has become fashionable to call "issues." Israel has a hybrid system (which I'm not an expert on but you can read more here). The financing is single-payer, but the delivery system is a mix of public and private providers, and nonprofit "Sick Funds" that are roughly similar to big HMOs but with historical roots in the labor movement. Basic benefits are guaranteed, and people can purchase supplementary benefits. But even the basic packages covers OT for kids with learning challenges. I forgot how many visits she told me were covered, but it was pretty generous. She was stunned to find out that even really good employer-sponsored health insurance in this country might not pay for a single visit. Or pay for only a few visits, with really high co-pays. She was incredulous. "But what happens to the children?" she asked. Good question.