"Big Insurance: Sick of It" Rally

"Big Insurance: Sick of It" rally on September 22, 2009, held in front of Blue Cross Blue Shield's offices in Chicago.

"Big Insurance: Sick of It" Rally from Justin Jach on Vimeo.

Five Myths About Health Care in the Rest of the World

Journalist and author T.R. Reid set out on a global tour of hospitals and doctors' offices, all in the hopes of understanding how other industrialized nations provide affordable, effective universal health care. The result: his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.

Listen to a great interview with Reid on NPR's Fresh Air | Read the transcript here

By T.R. Reid:

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

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.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

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.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. 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.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

Source: washingtonpost.com

Reid is a foreign correspondent for The Washington Post and the former chief of the paper's London and Tokyo bureaus.

Reid was the lead correspondent for the 2008 Frontline documentary Sick Around the World, which examined five other capitalist democracies, looking for lessons on health-care delivery. His books include Confucius Lives Next Door: What Living in the East Teaches Us About Living in the West and The United States of Europe: The New Superpower and the End of American Supremacy.

Lincoln Mitchell: Fearing Government Involvement in Health Care

Medicare, Medicaid and veterans' benefits have become an indispensible part of our health care system providing valuable services and benefits to people, many of whom would have very few health care options were it not for these government programs. This is something which should be kept in mind when scare tactics about government takeover of health care are used. These programs also demonstrate the inaccuracy, or perhaps nuttiness, of some of the more outlandish claims about Obama's proposed programs. For example, if the government were really going to ration health care or set up "death panels" as part of government health care programs, wouldn't the government have started by doing these things to the poor, the elderly or disabled veterans-precisely the people who rely on the government for health care today.

Read it all.

The Myth Of Rationed Health Care

From Progress Not Congress

If you believe that the U.S. government is going to model its care after countries like Canada and Great Britain, who supposedly ration their health care, ask yourself the following questions.

1. If the elderly in Canada receive less medical treatment than Americans due to the practice of rationing, why is their life expectancy 81.2 years, over three years higher than in America?
2. If the elderly in Great Britain receive less medical treatment than Americans due to the practice of rationing, why is their life expectancy 79 years, a year higher than in America?

Looking at the facts, one is forced to come to one of two conclusions.

1. The government run health care systems in these countries do not ration their care, and there is no truth to this bogus "rationed care" argument.
2. Rationed health care leads to people living longer (this conclusion is, of course, ridiculous).

Either way, if Americans want to live longer, they should want their health care system modeled after countries who have a longer life expectancy.

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Doctors Say Health Care Rationing Already Exists

"In America, we strictly ration health care. We've done it for years," says Dr. Arthur Kellermann, professor of emergency medicine and associate dean for health policy at Emory University School of Medicine. "But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."

Kellermann still remembers the young mother of two who came into his emergency room more than 15 years ago, suffering from a hemorrhagic stroke.

"We worked for 90 minutes to save her life, but basically she had burst a blood vessel in her head. She didn't have a chance," he says. "She had no health insurance, and when the money got tight, she had to make a choice — she could either buy the groceries for her kids, or she was going to buy the three blood pressure medicines she had to take every day."

Sadly, Kellermann says, for less than the cost of that futile, 90-minute effort in the ER, the woman could have had all the blood pressure medication she needed for the rest of her life. It was not a government bureaucrat who decided she should forgo treatment until it was too late — it was her own lack of health insurance that led her to make that choice.

It's not only the uninsured who are affected. Americans who do have health insurance tend to get a lot of procedures after they're sick — not because bureaucrats dictate that, but because that's what insurance and Medicare pay for.

Rationing is not limited to the health care industry. No other country devotes as much of its economy to health care as the United States. While Americans might not think of that as a choice, it means they have less to spend on everything else. Government payments for health care come at the expense of schools, roads and other services. The extra money that employers have to pay for rising health insurance premiums is money they cannot put into workers' paychecks.

"No worker gets to say, 'You know what, make my premium $1,000 lower by getting me a more efficient health insurance package, and at the same time, give me $1,000 more in take-home pay,' " says Harvard economist Katherine Baicker, who has studied the impact of rising health care costs on employee compensation.

So while there is no government rationing board handing out coupon books for heart surgeries, more and more of the nation's resources are being gobbled up by health care, often with little choice for individuals, and often in ways that no sensible person would choose.

Read it all at NPR

Um...isn't healthcare ALREADY being rationed?

How many millions of Americans can’t go for preventative care because it is cost prohibitive? How many people have died because an insurance company denied coverage – even retroactively? How many people have lost their homes, jobs and everything they own because of the controlled distribution of healthcare by those who should not be making healthcare and medical decisions?

With the added stress on the economy today with the hundreds of thousands of job losses each month, is the lose your job, lose your healthcare coverage not de facto rationing? When Americans are referred to as healthcare consumers who should make "informed decisions when purchasing healthcare", as opposed to having a basic right to basic preventative care and coverage for common ailments as well as for catastrophic accidents or injuries – how is that not dictating what gets covered and what does not?

When the emergency room is the only available resource to millions of families - especially for things that could either have been avoided through basic preventative care or a simple visit to a physician, how is that not leaving very little choice for these families? When a choice has to be made between medication and food or heat or clothing because insurance and drug companies (who get billions in subsidies) make their products too costly – how is that not rationing healthcare?

It is absolutely insane for anyone to make the argument that expanding coverage (even if it is basic coverage and only "a few million families") to more people so that they can take extra precautions or catch potential diseases earlier or free up emergency rooms for those who really need it will result in "rationing healthcare".

Rationing healthcare by people who have no business making these decisions is already being done on a wide scale. It’s even being called "managed care" and has been taking the healthcare decisions out of the hands of doctors and patients for years now.

We already have healthcare rationing...