Healthcare - Frontline Subject

[chinaco]

Frontline on PBS had a documentary on Healthcare "Sick Around the World"

The journalist visited 5 developed nations and discussed their Universal Healthcare system.

Each country had a slightly different approach.

There were a few criticisms, but for the most part the outcome was positive.

The people involved did not describe it to be the negative expereince we have been hearing. Even some of the people who were against Universal Health care thought it to be positive.

It dispels some of the myths (rhetoric) we have been hearing. Bottom line - Sounds like we have been hearing bull$h!t from the critics [-]those who profit[/-] of UH.

They essentially took most of the high level of profit out of it. Surprisingly, it has not affected innovation in the industry. Some people make a little less money and companies make a little less profit. But no one is hurting. Naturally if someone stops making very high profits or wages they are not happy.

Several of these countries converted to UH in the last several decades.

Most countries spend less per capita, do not wait for service and have better health stats.

In general all of them required one to be in the system (no opt out/or be excluded). The government negotiated/regulated the costs.

FRONTLINE:sick around the world | PBS

It is time for UH.

 

[walkinwood]

I agree!

My friends and family in Canada and the UK love their health-care system and can't comprehend our lack of universal healthcare. When I told them what I'm going to pay for individual health insurance, there was total disbelief. Then I told them all that I was NOT getting for the huge premiums.

It isn't just the insurance companies - its the pharmaceuticals, the metrics, the doctors, the equipment providers and the hospitals.

 

[maddythebeagle]

There were a few criticisms, but for the most part the outcome was positive.

I think they glossed over some key problems including an expert in Japan saying that half of the hospitals were in financial trouble and the doctors in Germany picketing because they didnt get commensurate pay (although it sounds like med school was subsidized and mal. insurance was low)...

I think it was Germany that still had an insurance system still but was "not for profit" but still had competition for enrollees, which I didnt fully understand....sounds like the insurance group gets some financial incentive for the number people they sign up or retain?

 

[Eagle43]

I watched the program. A hospital room with 4 people in it cost $10/nite in Japan! I was amazed at people in all of the countries saying that they never heard of bankruptcy because of medical bills. The moderator quoted 750,000 medical-caused bankruptcies yearly in the U.S. Is this true?

A good program, though. It presented pros and cons to the issue, even if the moderator was clearly in favor of national health care.

 

[Coach]

I thought the program was well done, but I admit I'm a big fan of T.R. Reid. I found it encouraging. I've worried that maybe we've just taken too long to get to health care reform, but a couple of the countries he visited have gone through the process quite recently, and seemingly successfully.

Coach

 

[2good]

To the question posted by mdb (I think they glossed over some key problems including an expert in Japan saying that half of the hospitals were in financial trouble and the doctors in Germany picketing because they didnt get commensurate pay (although it sounds like med school was subsidized and mal. insurance was low)...

I think it was Germany that still had an insurance system still but was "not for profit" but still had competition for enrollees, which I didnt fully understand....sounds like the insurance group gets some financial incentive for the number people they sign up or retain?):

Summary of HC system in Germany:
- Everybody gets accepted
- Your contribution is a percentage of income, not a fixed amount. So everybody can afford health care.
- HC contribution gets deducted from pay directly (employers responsibility). This basically prevents people from 'opting out' by spending the money otherwise.
- The administrative work is still done by insurance companies. They compete for customers. (but the rate per customer is fixed percentage of income, see above)
- The Problem: In order to keep costs down the government caps rates for hospitals, services, and doctors. Doctors are unhappy earning $150,000 while seeing on the news the doctors in the U.S. earn twice as much.

Overall, the system works pretty good. Quality of hospitals and doctors seems comparable to here.

 

[HFWR]

Those German doctors can move to the USA, where their diagnoses and treatments can be second-guessed by insurance company bureaucrats, and they can be smothered in incomprehensible paperwork and regulations...

To make sure they EARN those extra bucks...

 

[maddythebeagle]

I didnt hear that they made 150k/yr...I heard one say 80k...Not arguing against some kind of universal care in the U.S. since I think it makes sense but that is a lot schooling and training to expect people not to do an easier job for similar money...I think these other countries are ignoring the economics quite a bit...it has to all come out in the wash and somebody has to pay...

 

[Khan]

I didnt hear that they made 150k/yr...I heard one say 80k...Not arguing against some kind of universal care in the U.S. since I think it makes sense but that is a lot schooling and training to expect people not to do an easier job for similar money...I think these other countries are ignoring the economics quite a bit...it has to all come out in the wash and somebody has to pay...

The question is: how much do the doctors have to pay for their education?

 

[Rich_by_the_Bay]

The question is: how much do the doctors have to pay for their education?

Figures in the $200K range are routine for indebtedness for med school and residency. The opportunity cost of a an 8 to 12 year delay in retirement planning while paying off debts may be an even bigger sacrifice for some. One can do it cheaper in public schools, on the cheap, working spouse, etc. but still in the $100K-$150K range I'd guess.

My last educational loan repayment was at age 40. My contemporaries in law and business had 10s of thousands invested by then.

 

[Khan]

Figures in the $200K range are routine for indebtedness for med school and residency. The opportunity cost of a an 8 to 12 year delay in retirement planning while paying off debts may be an even bigger sacrifice for some. One can do it cheaper in public schools, on the cheap, working spouse, etc. but still in the $100K-$150K range I'd guess.

My last educational loan repayment was at age 40. My contemporaries in law and business had 10s of thousands invested by then.

I was aware of the outrageous costs in USA.

I was wondering about the out of pocket costs for the doctors in Germany.

 

[2good]

University education is generally free in Germany. Some states recently started to introduce a fee of about Euro 500 per semester to encourage timely completion of courses.

 

[chinaco]

I didnt hear that they made 150k/yr...I heard one say 80k...Not arguing against some kind of universal care in the U.S. since I think it makes sense but that is a lot schooling and training to expect people not to do an easier job for similar money...I think these other countries are ignoring the economics quite a bit...it has to all come out in the wash and somebody has to pay...

One either thinks the USA can improve their health care system or not.

This document shows some stats similar to what Reid quoted.

We spend more (almost twice as much per capita). And look at our rankings.

• US rank 26 in infant mortality in Industrialized nations
• US rank 24 in disability-adjusted life expectancy

But the US ranked 1st in caregiver responsiveness.


http://dll.umaine.edu/ble/U.S. HCweb.pdf

I think it is time for UH.

Most working people are 1 health care crisis away from bankruptcy or financial ruin.

I think UH has been painted unfairly by people who stand to benefit from the status quo.

Unfortunately many people buy into the negative picture. I did at one time.

For that matter I have health care for life here in the US. But I still think it is to our advantage to institute UH. If we do not costs will continue to sky rocket.

You commented about the HC deficit some countries are running. It is a political thing. They can pass the bill to cover it. But remember, we are paying more than everyone else.

What are we getting for it? We are becoming health care poor and almost 20% of our citizens do not have access because they cannot afford it. And most of those people work!

 

[DallasGuy]

I didnt hear that they made 150k/yr...I heard one say 80k...Not arguing against some kind of universal care in the U.S. since I think it makes sense but that is a lot schooling and training to expect people not to do an easier job for similar money...I think these other countries are ignoring the economics quite a bit...it has to all come out in the wash and somebody has to pay...

I think doctor's should make a fair wage, but I don't think that how much a doctor makes should be the main deciding factor in choosing whether to have Universal Health Care or not. If we get UH, there's nothing stopping a doctor from still having his own practice and charging whatever the market will bear. Also, his/her income should not be guaranteed....just as I've taken a paycut as a contract computer contractor after the outsourcing to India has recently taken place. That is just the nature of incomes in times like this...there is no guarantee....and there probably shouldn't be. Having said that, I do believe that some sort of UH should eventually be put in place because currently our health care system seems to be largely run based on profit potential and not on how well it serves the citizens in the U.S. I feel a health care system should be run more like a utility company where there are fair, but not obscene, profits built into it.

 

[chinaco]

if health care costs in the US are a substantially higher amount of our GDP compared to other industrialized nations... and they have good health care systems (which they do). The we are paying too much for health care (an inflated rate).

Cutting health care costs (not over paying) would seem to be important to our economy. Cutting it and providing care for everyone would seem to be important to the US economy, individuals safety from financial ruin due to health problems, and individual personal health.

I have traditional healthcare for life through a retirement plan from DW. With a backup from my employer. Both are very affordable. So I have little risk except for rising health care costs.

But I still support Univeral Health care in the US. I think it is important to our personal and economic well being as a nation and to businesses.

 

[mark500]

You can ration health care in a free enterprise system like we do now. Or you can ration health care by central decision making entities. Either way, costs will be controlled - The demand for health care is insatiable.
For example, in some countries with "universal health care", long term hemodialysis is limited to people under a certain age. That age is determined by a central decisoin making body, not the patient. Limitations on who qualifies for an MRI or CT based on symptoms. Delays of months in non-urgent CT/MRI. Delays in seeing specialists.
Varying degrees of cronyism. Who you know can get you in quicker.
Plus, forget about the current medical tort system as it is (which is a good thing). No way the governement is going to subsidize trial lawyers who take 30-40% of monetary awards.

I don't have a problem with centralized universal health care. Just be aware of the trade-offs.

 

[Alan]

Thanks very much for posting - I enjoyed watching it. Having had 32 years in the UK system and still have lots of relatives living there I hear the good, the bad and the ugly all the time. In the UK, even while I still lived there 20 years ago, you can still have private insurance, which I did, to leap frog waiting lists for elective surgery such as hip replacements etc - I'm surprised that wasn't mentioned.

For the UHC system it seems to be a zipcode lottery in that the waiting lists vary enormously. DW and I both have relatives and friends experiencing this dramatic difference just because of where they live - and I'm talking major stuff like heart valve replacements, brain tumors, back surgeries etc.

I do think the US needs major health reform

 

[Ed_The_Gypsy]

Having lived and worked here in Canadistan for several years, the local health care system seems to have pluses and minuses. Several things are excluded and private health care or insurance is generally illegal. I like choices. I also like to get health care when I want it. Waiting 3 years for a colonoscopy that my US doc said I needed now didn't suit me. Friends who worked in Japan for several years were aghast at the Japanese medical system. The 'two-tier' system used in Latin America seems to have something for everyone at prices I can afford. Until them, DW keeps working and we get health insurance through her job.

Health care reform in the US? Don't hold your breath. Find what you like somewhere else.

 

[kcowan]

I insisted on a colonoscopy because a friend was struggling with colon cancer. Doc said it was not necessary. Waited 3 months. He was right...

There is no perfect system. What bugs me is all the politics. Why not strive for best-of-breed?

 

[Grizz]

I'm Canadian so especially during my highest income years I pay a great deal more tax, both payroll and hidden (think $4.75 gallon) than an American does, mainly, I'm told, to support our UH. Of course the trade-off is that I presumably pay much less than an American once I retire and my income becomes less.

I'd like to spend winters in the U.S. some day. I'm curious, how much does decent health insurance cost in the U.S? I'm sure that it varies according to deductibles and the like, but how about a family of four, mom and dad are 40, kids are 10 ish and in good health. How about the other end of the spectrum? A 58 yr old guy who smokes, is overweight, and has had heart issues? An exact # isn't necessary, just a decent ballpark figure. Also, is there a cap to what you can be charged? Are there laws that guarantee that an insurance company must cover you or are there walking wounded in the U.S. that have plenty of money but no coverage, or coverage for everything but can't get any for their pre-existing health issue?

 

[Coach]

Grizz, your questions are almost impossible to answer. Insurance is the US is regulated by the states, so the answers vary from state to state. Martha's FAQ on private health insurance is a good place to start.

Coach

 

[ladelfina]

Grizz, if you maintain Canadian residency, you should probably look into special travelers' insurance. I don't think US insurance from state X is what you are looking for if you are not a US resident and a resident of destination state X.. (although I guess there's the off chance someone might take you if you maintained a US address and were willing to pay 12 months' of US premium$).

I can't vouch for the reputations of any travel health insurers, but I usually buy into it for trips to the US just in case of emergencies like an auto accident. Last year I paid for 2 weeks at about $60 for $1mm - $1.5mm max coverage.. this is FAR less costly than "normal" US insurance, but may also cover less stuff. I have no experience with filing claims (knock on wood!). The good part is you can quickly get a quote online and sign up for instantaneous coverage with a credit card. I have used this one:
New Site (www.sevencorners.com)
but there are many others.. just search on "travelers health insurance". I don't know where you can get independent ratings of how good the coverage is.. but I found this comparison site:
Travel Insurance - Compare Every Major Company - Instant Cover

Are there laws that guarantee that an insurance company must cover you or are there walking wounded in the U.S. that have plenty of money but no coverage, or coverage for everything but can't get any for their pre-existing health issue?

Answer to all three is: yes (but I think only MA is guaranteed-issue -- someone must cover you, and you must pay, w/state subsidies for the indigent).