The information I am sharing with you is based on the work of T. R. Reid. Reid was a foreign correspondent--yes Virginia, newspapers used to have things called foreign correspondents and foreign bureaus, once upon a time--for the Washington Post. During his career, he spent a good amount of time living in England and Japan and, of course visiting many other European and Asian countries. While in these countries he and his family experienced their healthcare systems from the inside.
In 2008, the PBS series Frontline, used Reid and his experience for a documentary titled Sick Around the World. He re-visited five countries (England, Japan, Germany, Taiwan and Switzerland) for extensive interviews with patients, healthcare providers, government officials, insurance executives and healthcare experts in each country.
It has been more than 3 year since I first saw Sick Around the World, and there are two things that I still remember from seeing it the first time:
1) In each country, Reid asked "How many of your citizens went bankrupt last year due to medical expenses?" (In 2008, that number in the USA was around 700,000. I would expect the 2010 number would be considerably higher because of job losses accompanied by loss of medical coverage.) The answer from the President of Switzerland was "No one. If anyone did it would be a scandal!" Officials of the other countries said the same thing.
2) Around 1995, the Taiwanese formed a national commission to upgrade their healthcare system. They looked at the systems used by all the other nations to find what parts of their systems were working well and to learn from the problems in their systems. I remember thinking, "You've got to be kidding. The Taiwanese can do this without starting a civil war and the USA can't?! Seriously, the Taiwanese!!"
Reid went on to amplify his Frontline work into a book titled The Healing of America. He included additional countries, and was able to expand upon information first presented in the documentary. The book made it to the NY Times bestseller list. Here's the link to the book's page at Amazon.com:
I'll say a little more about the documentary later--including how you can watch it for free on your computer. But first, I need to make good on my promise.
You will recall that there are basically 4 healthcare financing systems in use. Here they are again, along with the countries that use them:
Method 1 - In countries that follow this model, both healthcare providers and payers are private entities. The model uses private health insurance plans, usually financed jointly by employers and employees through payroll deduction. Your doctor's office is a private business, and many hospitals are privately owned. (Germany, Japan, France, Latin America (to a degree). I didn't ask about them, but Belgium and Switzerland fit in here as well.)
Method 2 - In this system, healthcare is provided and financed by the government through tax payments. There are no medical bills; rather, medical treatment is a public service, like the fire department or public library. Many (sometimes all) hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. (England, Italy, Spain, Cuba and most of Scandinavia. Hong Kong also has a version of this system.)
Method 3 - The providers of healthcare are private, but the payer is a government-run insurance program that every citizen pays into. The national, or provincial, insurance plan collects monthly premiums and pays medical bills. (Canada. Taiwan and South Korea has variations on this system.)
Method 4 - Most medical care is paid for by the patient, out of pocket, with no insurance or government plan to help. (Cambodia, India, and most other poor countries of the world.)
When we left off yesterday, the question was which of these models does the USA use. Here's what Reid has to say on that subject.
1) "For most working people under sixty-five, we're Germany, or France or Japan. In standard Bismarck Model [NOTE: that's the real name of this model first put together 125 years ago by the German ruler of that name] fashion, the worker and the employer share the premiums for a health insurance policy. The insurer picks up most of the tab for treatment, with the patient either making a co-payment or paying a percentage."
2) "For Native Americans, military personnel, and veterans, we're Britain, or Cuba. The VA and much of the Pentagon's Tri-Star system involves doctors who are government employees working in government-owned clinics and hospitals. Following the Beveridge Model [NOTE: Named after William Beveridge, the reformer who inspired Britain's National Health Service] Americans in these systems never get a medical bill."
3) "For those over sixty-five, we're Canada. U.S. Medicare is essentially a National Health Insurance [the official name of this model] scheme, with the near-universal participation and the low administrative costs that characterize such systems. Americans with end-stage renal disease, regardless of age, are also covered by Medicare; this group had enough political clout to get what it wanted from Congress, and the "dialysis community" opted for coverage under the government-run NHI system."
4) "For the 45 million uninsured Americans, we're Cambodia, or rural India. These people have access to medical care if they can pay the bill out of pocket at the time of treatment, or if they're sick enough to be admitted to an emergency ward at a public hospital, or if they have access to a charity clinic."
5) "And yet we're like no other country, because the United States maintains so many separate systems for separate classes of people, and because it relies so heavily on for-profit private insurance plans to pay the bills. All the other countries have settled on one model for everybody, on the theory that this is simpler, cheaper, and fairer. With its fragmented array of providers and payers and overlapping systems, the U.S. healthcare system doesn't fit into any of these recognized models."
I'll close today's message by giving you a link to the PBS website, where you can view the entire 53-minute Frontline: Sick Around the World documentary for free. When you watch it (please, please invest 53 minutes in the single most important question in our country's financial future!), remember that you will not find any one system which could be simply plugged in in place of our current system. Instead, look for ideas that might make reasonable improvements in our current system. Things that might result in better health outcomes, while also reducing costs.
If you're on the conservative side, please don't think, "Oh, this is a waste of time. It'll just be another commercial for socialized medicine." I promise you that Reid points out the good points, and the warts, of each system. The only agenda he has is that, if we're willing to admit that there is intelligence in other countries as well as ours, we can use the healthcare experience of those other countries as a laboratory to help us improve our healthcare system.
Here's the link:
I'm going to spend one more day on this topic. Tomorrow I'll give you a "Readers Digest" summary of some interesting things in other healthcare systems, and answer a question I promised to get to on the first day of this topic.
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