Monday, November 2, 2009

Sick Around the World

This Frontline PBS documentary was very informative and can be viewed online HERE. It's a look at medical care systems in five countries: Great Britain, Germany, Switzerland, Japan, and Taiwan. Each system is slightly to greatly different, but each has three elements in common. These three crucial elements are the stumbling blocks in America where we tend to want our own piece of the pie, forget sharing the pie with the others. The following is an excerpt from the program's transcript, which is available online HERE...

"T.R. REID: What I've found is that it's not all "socialized medicine" out there. Many countries provide universal coverage with private insurance, private doctors, private hospitals, using market ideas that might work for us.

But here's the thing. These capitalist countries don't trust health care entirely to the free market. They all impose limits.

There are three big ones. First, insurance companies must accept everyone and can't make a profit on basic care. Second, everybody's mandated to buy insurance, and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices.

Can Americans accept ideas like that?

Well, the fact is these foreign health care ideas aren't really so foreign to us. For American veterans, health care is just like Britain's NHS. For seniors on Medicare, we're Taiwan. For working Americans with insurance, we're Germany. And for the tens of million without health insurance, we're just another poor country."

Let's look at those three things up close.

1. Insurance companies must accept everyone and can't make a profit on basic care.

This means that you cannot be denied coverage if you have a pre-existing condition. It also means that they are essentially non-profit. They can profit from elective care, for instance, cosmetic surgery not related to an injury, condition or defect.

2. Everybody's mandated to buy insurance, and the government pays the premium for the poor.

American's don't like to be "mandated" to do anything. We feel threatened by it; sense a loss of freedom. Well, we are mandated to pay taxes and we're paying through the nose and not getting much. My state can't manage money to save it's life. Our roads are pretty bad, at least in my area, our schools are pretty bad (compared to other industrialized nations), we don't have universal health coverage, thousands of children die each year in America do to basic neglect, etc...

What if the amount we're "mandated" to pay was actually less than what you pay now? What if it meant that you can never go bankrupt due to medical bills? Each of the five countries listed above think it's scandalous for anyone to go bankrupt due to medical bills; it's unheard of in their countries! Yet thousands and thousands of people in America are losing their homes DAILY because they can't pay their medical bills.

An overnight hospital stay in Japan costs just $10, $90 for a private room. Now, it is true that in these five countries, hospitals are in the red. But guess what? Hospitals in America are, too, and many are closing! The difference? We are spending a TON of money and we're in this condition. The other countries are spending far less. But, the quality of care is equal or greater in the five other countries!

3. Doctors and hospitals have to accept one standard set of fixed prices.

This one would really sting American doctors and hospitals because they are, after all, businesses, and want to make a profit. What was that? Yes, doctors and hospitals in America PROFIT FROM OUR ILLNESS! Hello, where is the incentive in that to practice preventative medicine!!!

But, guess what? By the time you take out administrative costs and malpractice insurance costs in the U.S. model, the doctors make about the same as the doctors in these other countries!

"A family doctor (in Germany) makes around $120,000 a year, about two thirds of what she'd earn in the U.S. But then, she has a lot lower overhead. Her malpractice premium is just $1,400 dollars a year, about a tenth of what she would pay in the U.S. And medical school didn't cost her a penny."

Simple facts:

1. Doctors in the U.K. are paid a bonus for keeping their patients healthy.

"...So when Dr. Badat does a good job of caring for patients with diabetes and heart disease, he gets paid more. How much more? (AHMED BADAT, M.D., "It works out about 90,000 pounds.") So that's increasing your salary by $180,000 a year. ...The result, Britain has become a world leader in preventive medicine."

2. The U.S. spends 16% to 24% or more on administrative costs. These other countries spend 6% to 8%!

"High-tech Taiwan designed its new health system using state-of-the-art information technology. Everybody here has to have a smart card like this to go to the doctor. The doc puts it in a reader, and the patient's history, medications, et cetera, all show up on the screen. And then the bill goes directly to the government insurance office and is paid automatically.

So Taiwan has the lowest administrative costs in world, less than 2 percent. Compare that to the endless paperwork and all the denied claims we get with for-profit U.S. health insurance.

The smart card can also be used in other ways.

TSUNG-MEI CHENG: If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out and then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well.

T.R. REID: That may be too much like Big Brother to get by in the U.S., but surveys show the Taiwanese are highly satisfied with their health care.

[on camera] How many people in Taiwan every year go bankrupt because of medical bills?


3. The American health care system is not really a system. It's a market.

On a personal note. Several years ago I had a bad case of the flu. I got dehydrated. When one is severely dehydrated, their gut cramps up like crazy and it's very painful. I had a friend take me to the ER at my local hospital (Northern California). I did not have insurance at that time. My treatment was this:

Vital signs taken
Blood/urine taken and run through the lab
2 bags IV ringers lactate
1 potassium pill
1 dose IV anti-nausea
1 dose IV morphine

The bill totalled over $4,000!

About four years later, still without insurance, I was in the desert and found myself dehydrated again. I went to the ER at the local hospital, which was in the middle of the Mojave Desert in Southern California. I had the same treatment and my bill was $500.

Another personal example of our strange insurance workings... When I began my adoption, I had to prove I had medical insurance and could provide it for Apple. I bought Kaiser at $176 per month. I was 37 yrs. old at that time, I'm physically fit, don't smoke or drink or have any health problems requiring medical intervention. I've never had surgery. For nearly two years I didn't even use the insurance and then I finally went for my "womanly check-up." All was well. When I turned 40, my insurance automatically increased to $256 per month! It will continue to increase as I grow older, regardless of how much money I make or how healthy I am.

We all have experiences and stories like this. You might even know someone who lost their home due to medical costs, or other outlandish situations. You might be a health care provider struggling to give your patients quality care, begging insurance companies to pay for certain life-saving procedures or treatments. My challenge on this front is to educate yourselves so that when you have the opportunity to affect change, you can do it fully informed!

1 comment:

Kim said...

Health insurance is crazy in general. This year I did a high deductible plan because the regular plans were so horribly expensive. Basically, my job gave me 1K not to run to the doctor with every sniffle. Fine by me, we used about $400 of that money and the other $600 rolls to next year.

I just signed up for the same plan next year.

I know lots of people with health insurance that are using public health clinics because their co-pays are so high.