Ideally, the Americans system needs to be a nonprofit system- with Aetna, United Healthcare and hospital systems, like HCA making $40-300 billion in profits each year how could our healthcare system work.
All companies should be nonprofit and follow the same rules and regulations. This will decrease administrative costs, allow for fair salaries in healthcare companies and systems while lower premiums. American capitalism is making healthcare unsustainable. The gap is widening between the haves and have nots.
2
I have not experienced healthcare in another country but my 25 year old daughter has, while living in New Zealand for one and a half years. The fee she paid to see a doctor in a clinic setting was not difficult to afford on her salary as an outdoor guide and the care provided was not affected by the fact that she was not a citizen. I do not know if her experience would have been different with hospitalizations. When she returned to the US, she and I spent over a year trying to find coverage for her that she could afford. We were not successful. A stumbling block was that she did not have a permanent address. That is not a particularly rare circumstance for young people doing outdoor guiding work. One very telling comment from her was that in her experience, people in New Zealand don't spend much time worrying or talking about health care.
My brother worked as a family practice doctor in Scotland and New Zealand during his medical work in the US. Had family circumstances allowed, he would have happily moved permanently to either country to practice medicine.
I am 66 and have Medicare. I am very happy with my experience. I am not sure yet what is the best plan for our country but I very much appreciate your comparisons with other countries. The US has no excuse for our lack of care for so many in our country, the limitation on care particularly for people of lower income, and the complexity of our so-called system. We need to learn from the world and do much better.
3
Here is my background . I am retired, and over 65, so have an abundance of experience with Medicare; I have lived and worked as an expat, meaning that while I worked overseas as a taxpayer to the country I was working in, I had the choice of using that countries national healthcare system or the private health insurance provided by my employer in the US. My family ( at the time, included , 3 school age children ), while living in the UK, France, Netherlands, Sweden, Germany, Norway, Italy, etc, always used the applicable countries system at the time because we found it completely satisfactory...this included a snapped achilles tendon, my sons head injuries, an appendectomy, internal bleeding in the gastro intestinal area, etc. So I have experienced whats out there, unlike your panel who appear to be a bunch of theorists. Its a totally bogus analysis. The US should alwys have the lowest ranking, if it has to be considered, mainly because 20 to 20 million people aren't covered by the ' system ' , and one totally neglected consideration, which is bankruptcies caused by medical costs..with the exception of the US, none of the ' competing countries have heard of such a consequence. As, previously stated, this is a totally bogus analysis.
7
I broke an ankle in Italy and it was not properly diagnosed, but I paid nothing to be seen in the hospital emergency room and have it x-rayed. They taped my ankle and told me where to buy crutches. When I got home I followed up with my doctor, who couldn't even read the x-ray (it was so out of focus), and he re-did the x-ray and put me in a cast.
Some years later, I burned my foot with boiling water in Canada (bad foot karma?) and went to the nearest (rural) hospital for treatment. Again, I walked (limped?) in and was seen that day, but not that minute: in that facility, all the chronic care was done in the morning with scheduled patient appointments, while all "emergency" care (obviously not severe trauma) was given in an afternoon clinic. I returned for follow up care a few days later, with an appointment. I paid nothing, and in the Canadian example, received excellent care.
I think if I needed to access emergency care again outside the US, I'd prefer it not to be in Italy, but in neither experience was I ever asked for ID or insurance or to make a payment. It was lovely and helped reduce the stress of being injured on vacation.
2
The USA should deliver low cost health services directly to those who need it. But it is stupid to dismantle the private system entirely,
And without the US system -- which encourages innovation and quality for the few -- the rest of the world would be left with old technology and crappy generics just as medicine turns to individualized approaches including genomics and real world evidencw based medicine that offer the best outcomes, lowest cost and most individualized control.
1
It would be very helpful to make this a series, with more detail, including sample pricing and financial responsibilities of citizens. For example what does a healthy 48 year old single making $35,000 a year pay, what kind of plan, from country to country, vs. a family of four making $100,000 a year? In the US costs also vary from state to state. Georgia has higher subsidies for ACA coverage for me than Louisiana did. Love the article, and it's very important, but a continuing series with more detail would be great. For example, a colleague paid $120 a month in France for premium insurance for a family of four, and said there were no additional costs. I had this conversation after a sudden, unexpected, and ultimately pointless ambulance trip to the emergency room called for by a doctor when I had some stomach pains cost me $1,400 after silver plan insurance was applied! (Total bill was $8,000). She was horrified for me, and said her husband had an aneurysm and they had no additional costs. While I realize each situation is different, not including example costs makes it all a bit nebulous. Thank you for keeping the comments open for feedback!
2
An anecdotal opinion from someone who's a younger individual, with fewer exotic health problems, and lived and dealt with the systems in the US, UK, France, Singapore, and Australia.
To me, Australia and Singapore have been the least frustrating to deal with, and provided the best care, though I recognize that as an educated skill worker my access was likely higher than your average person in Singapore, which would give Australia the nod. I received adequate, compassionate care in France, though my insurance was pricey. The idea that the UK could win even one of these comparisons is laughable to me, with my months-long pre-Brexit wait times for care and the horror stories from British friends' neglectful treatment.
I'm curious why Taiwan's system wasn't tapped for comparison. Would be curious to see how it stacks up in these experts' opinions.
4
I had hip impingement. A bone spur was ramming into my labrum. I went to four doctors (includes my GP) and all abstain from physical exercise, take anti-imflammatory and get physical therapy. I did just that over a 2 year period. Then I requested surgery to fix the problem/pain. I asked my Ortho doctor will this be covered by my insurance. He said YES. The day of the surgery I arrived at the surgical center and my wife was told it was "out of network" and that she needed to write a check for the cost. Then the anesthesiologist turned out to be "out of network". Later after the surgery, the insurance company sent me a letter saying they would not pay for the surgical costs. They said I did not abstain from physical exercise or take anti-inflammatories. All this was false of-course. I had to battle them and finally they agreed to pay it. In the end, I felt I got screwed by both the Doctors, surgical center and the insurance company. This was in California! I got played! Now I tell everyone to get everything in writing from ALL parties!!!!!!!
Don't assume anything!!!! Document everything!!!! Trust no one!!!!
2
So many comments, please excuse if I repeated the concept -- but the fee for service and revenue generation of our system (and I'm a physician) need to be looked at. A widespread epidemic of burnout is happening in our system and some of it is tied to our training standards, debt loads, and the need to "do more" to make more.
Simple point: If I ask a 92yo about their family history when they are admitted for dehydration then I can charge higher? What ridiculous system incentivizes the unnecessary?!
I see so many instances of up-billing or excessive procedures fueled by fee for service.
That aspect of any healthcare needs to be addressed.
2
Don't get sick.....
3
It has been awhile (1988) since I was a patient in a British hosptital and they were unable to diagnose a ruptured appendix. While the British patients all raved that their care was free, many had been admitted weeks before and had yet to be diagnosed. The ward had 12 crank beds with men and women, one bathroom and the nurses made toast for breakfast. Knowing that I would not survive if I remained, I checked out of the hospital and flew to an American military hospital in Germany. Amazed that I had survived the flight, the doctors operated immediately to save my life, though I was both malnourished and dehydrated from my stay under British care. The infection was so bad that I remained a patient for nearly 6 weeks. I hope the Brits have improved since then.
1
There is one national health care sytem that should have been discussed and compared in this column, but wasn't. The Veteren's Affairs health system in America.
I get my health care from the VA and it is the best health care I've ever had. I've had the same doctor for about fifteen years and he is very good. He always spends as much time with me as necessary and never tries to cut the visits short. He is always courteous and caring, and very thorough. He never stents on lab tests.
If there is a downside to my receipt of VA health care, it is that for surgery or more complex medical procedures, I may have to drive to VA facilities in other cities in Michigan. But, for me the longest drive is an hour and a half, not that big a deal.
The VA health care system is an example of pure socialism - the government owns the hospitals, the government pays the doctors. Despite the occasional negative story in the press, the VA provides excellent health care and has excellent health care outcomes. One advantage of this system is that I can go to a VA clinic anywhere in the country and the doctors and administrative staff will have instant access to my medical records.
Instead of Medicare-for-all, we should be talking about VA health care for all.
5
American healthcare seems appalling but certainly the VA system sounds very much like the British NHS
One important thing not mentioned in the article is the whole attitude to the patient The fact is that ANY system where any kind of PAYMENT is involved introduces a different attitude to a free system
The question is ....^Is the health system designed for doctors(to show their skills /help them earn high salaries etc ) or is PATIENT CENTERED
The British NHS is overwhelmingly PATIENT CENTERED....Hospitals doctors etc are not there to show off their years of training although they are obviously doing this but there is a sense of caring that is missing from other mixed type systems
Because the NHS is so huge etc) there can sometimes be scandals etc relating to care which are all investigated and dealt with but there is no question that from the patients point of view it is the best in the world When patients in desperate well publicised cases raise money to go to America fror treatment for children etc those American treatments have always be examined and discarded and not used because they do not work Also remember that the surgeons who work privately also work in the NHS..there is no distinction
However would an NHS style system work in the US? The idea of 334 million people being enrolled is impossible to imagine but anything is better than the present horrific system
the fact that the British system allows for a parallel private system is it's saving safety valve.when I lived in England, admittedly a long time ago,if you were above a certain age, like 55, you could not get an operation for a hernia! however, if you had supplemental private insurance, you were treated like a king. your private insurance paid only a tiny fraction of the actual cost of your hospitalization. But that was sufficient to buy you excellent care and put you at the head of the queue. for this reason I don't see the British system as being all that egalitarian. Those who could afford the private supplemental insurance got prompt, excellent treatment, including a private room, whilst the unwashed had to wait in wards for treatment that they might never get.
How much of the US’ excess cost of medical care comes from monopolistic pricing of drugs by the pharmaceutical industry due to our patent laws? Other countries pay far less for drugs than US consumers do.
1
Out of Date. Brexit has destroyed Britain system.
1
I've lived in the US, Ireland, France and Switzerland, have been covered by each of their healthcare systems and although it is relatively costly, the Swiss system wins over the others very easily. Care quality is good, it's pretty equitable, and the private-public balance mostly works well. None of them are perfect, but I wouldn't choose any other system in the world for being sick, having chronic illnesses, giving birth, having a handicapped child and more - all of which we have experienced in our family. The peace of mind it gives us is truly liberating. The key features that make it work: obligatory health and accident insurance; social security backup for the unemployed or needy; option to choose the insurance company which gives rise to competition; financial participation by employers and employees (gets more costly when you retire - ouch); government oversight to keep costs down. There is a lot of public grumbling that the last bit doesn't work as well as it should, with costs rising, but compare it to anywhere else and we certainly get value for money.
5
What people do not understand with the German system and possibly with other systems (I only know the German system) is that it is not completely funded via taxes. People pay a percentage of their wages if they are on the national plan. On the private plan they pay a set fee, increasing with age. So it is not really like a medicare for all.
2
First, provide basic, preventive, and other not-exorbitant healthcare to everyone, free or at most $5 per visit. Include emergency, dental, vision, and mental health. Diagnose and treat problems early and well, getting better outcomes while greatly reducing costs - while eliminating mountains of paperwork and the continuous stress and worry about access and coverage.
Very expensive treatments, such as heart transplants or $100,000+ cancer drugs, will need political debate to decide what the public will pay for. Optional private insurance could cover what the taxpayer doesn't.
Care ^gets more costly when you retire...Ouch!^ just when you need it in fact! I will stick to the British NHS anytime!
1
I know this will NOT happen, but please, stop calling professionals "providers." To see why, please read what my friend and colleague, Dr. Karen Shore, said about it in a speech upon acceptance of the "1997 Distinguished Psychologist of the Year" Award from the American Psychological Association's Division of Independent Practice.
~~~~~
Don't Let Them Take Your Mind and Spirit:
On Being Called a "Provider"
By Karen Shore, Ph.D.
It has been six years since I began speaking out against managed care (MC). From the beginning, I have focused on the industry's use of power, and how mental health services, education, and training would be destroyed. As I speak around the country, the most common question people now ask me is: "How did you know? How did you know in the beginning what they (MC) would do?"~~~~~~
YOU CAN FIND THE REST OF HER SPEECH HERE: bit.ly/KR-Provider or, if you are wary of a Bit Link from a stranger, here is the long URL: https://web.archive.org/web/20060925212219/http://nomanagedcare.org/provider.html
With 600+ comments, someone may have suggested this: it would be interesting to have the panelists rank choice their preferences and see which country's system comes out on top.
As a foreigner with very good insurance, I lived in Spain, China, and Singapore and also managed to find myself in situations where I needed varying degrees of medical treatments. In all situations, I got very good good care, so that was never an issue. But what I learned was that I got the 'top line' of the local healthcare systems. My friends/colleagues who were nationals of those countries and who had insurance through their countries' systems told me they would have had a more difficult time getting access to the doctors I saw and would have found - in some cases - the costs to be relatively high.
My point is that a country's health care system can be very good in terms of number of physicians, number of highly trained specialists, availability of the latest technologies and treatments, access to effective drugs, but not everyone can get access to all of that.
To build the 'best system' in the US, we need a lot more discussion around what our goals are and then build a system that puts all the resources in place to support that system. We aren't there yet.
5
The fact that you have to ask about these things at all is mind boggling. Yes, we in the rest of the civilized world have different methods of achieving the same goal, but we have the SAME GOAL - to cover everyone. I don't think it matters so much how you do it, it's that you need to be on the same page and agree that it is essential. Then you are in a unique position in that you can take the best of any programs around the world - including ours here in Australia - and make something that truly works well for Americans.
Step one, though, is to acknowledge that the health of your citizens is important enough to make any investment. You still haven't figured that bit out yet.
4
I have had insurance with one of the public option nonprofit insurance firms in Germany for the last 18 years. The care has been great: wonderful doctors, rapid access, hardly any copays, affordable premiums (they rise or fall according to income). There is also the huge factor of not having to worry about losing access. If Americans could only experience this, they would never look back. I do know people who are frustrated with their coverage; they are those who chose private insurance when they were younger and the premiums were low. Now their premiums rise with age (not so with the public insurance here, which rises only when your income increases), and they have a lot of work sorting out bills and copays with their private insurance companies.
3
To me, there are three fundamental shortcomings of our health care industry:
1, 2: We do not provide enough support to our less fortunate people, i.e. 1, people with high health care costs, and 2, low income people who cannot afford even average health care costs.
2. Our health care market is basically impossible for its consumers (and many providers) to understand, so it performs very badly as a market.
The bottom line is that we should be trying to deal with 1. an insurance problem, protecting people with high needs, 2. a distribution problem, protecting people who cannot afford insurance, and 3. a market failure problem in that the market does not come close to satisfying conditions for competition.
1
Im curious, when the NYT reports that there is a "lack of data" from the Singapore system vs. other nations, what data are they referring to? Since 2 of the judges made reference to this as an important point, what kind of insights are they expecting to deduce from the extra data that would influence the perception?
1
The comparisons I would like to see are of wait times for various health issues, such as how long after a diagnosis of cancer until you receive treatment, or diabetes, or how long until a senior received a hip replacement, for instance, after the decision to have it done, how long it takes to see a medical specialist after you've been referred, what's the percentage of cancer survivors after 5 years? 10 years? What's the percentage of seniors in excellent health at age 65? What's the number of MRI scanners per million people? How many General Practitioners per hundred patients, how long to get in to see the doctor when sick, or just to get a check-up. It's not just about the money, how soon can we get well?
2
You left Israel's health care system off the list, so this discussion is really pointless. With an EMS that receives no money from the gov't, relying solely on donations and billing, their MCI and Disaster Response training and protocols are unequalled. Everyone belongs to one of 4 HMO's and patients participate in managing their own care. This tiny country is more advanced in almost every way and you left them off the list, making the whole article a waste of time.
1
What people seem to forget or ignore about health care in Canada is the distances people have to travel. There are many remote villages, towns and cities and it is that distance which provides the greatest obstacle to service. Having lived under the the healthcare system in Canada and the US for roughly the same amounts of time, I can unequivocally say that Canada's is far superior, Yes, the very best of the US healthcare is terrific, but only the very wealthy get that. For even a upper middle class person with PPO corporate insurance you receive horrible medical care in comparison with waits every bit as long or longer than Canada. Plus you have the expense! After paying huge amounts per month in premiums you then have out of pocket and also co-pays. The system is rigged to give you the least amount to care for your dollar. The US system has a lot to answer for, in my experience.
2
We have traveled to Italy for health care for many years and believe it to be FAR SUPERIOR to anything we have experienced or observed in the US. Medication costs are fractional. One eye drop for my husband purchased in the US as a generic medication was $240 many, many years ago. The same drug only the name brand version was $12 in Italy and has since dropped to $9. The exorbitant costs in the US encourage both doctors and patients to try alternative therapies that can and do put the patient's life at risk.
1
I have found the competitive and highly efficient health care program of Holland [the Netherland] to be the most culturally acceptable to the US culture of both Republicans and Democrats. Has anyone studied it and compared it to the others?
I believe there are elements of the Dutch health care system that require a financial rigor that I believe would appeal to a market economy that also has concern for the welfare of all its citizens.
I hope your critical mind would access and compare also the cultural and market reality of the Dutch model as we need a way forward in our country that is culturally and financially acceptable.
Ps I did live in Europe for 24 years and had occasion to use the Belgium, Dutch, Italian, and Spanish health care system.
1
The key point in the British system is that it is a great mix of public/private. When you take out private insurance, you don't receive any tax benefits from that. You take yourself out of any NHS queue freeing up space for others.
No one says that the NHS gives the very best possible standard of health care but it is certainly good and it is always a public ambulance that services you when needed.
It can always improve, of course! But it is infinitely preferable to the ridiculous costs and huge waste in the US system.
1
Years ago, perhaps 1999 I needed care in Greece for a foot blister or close and I couldn't walk. They treated me with open arms as a tourist and charged nothing, even for a follow-up visit.
1
I've read the article and many comments, but at the end of the day, I still maintain that the US is behind all other developed countries in healthcare simply because of lack of universal healthcare coverage and because of enormous healthcare costs. These two things remain unjustifiable, even if services in the US are the best (which often isn't true).
1
As we tend to look down upon countries without democracy like China, Saudi Arabia as under-developed in terms of Human development we should consider US as non first world country till it gets universal health care.
Even countries like India [clearly a developing country in terms of HDI] has affordable care with government hospitals in every city and village with good health care. Medicaid is sort of similar but doesn't even come close to serving the purpose as the overall health care cost is ridiculous due to too many profit oriented players. [That is medicaid at this cost is a much inferior solution to something like NHS or government hospitals in India]
My friend injured his shoulder during a bicycle accident and the shoulder pops out every once in a while. While visiitng France he fell on the steps to the Louvre and his shoulder popped out. A policeman called an ambulance, he was taken to the hospital, had his shoulder fixed and left. No one even asked his name. There was no registration desk. They just treated him.
1
I’ve both been a patient and health care professional in Ontario hospitals. I’ve always received and given excellent healthcare in a timely manner . No patient is turned away for lack of funds because we are all covered . We can choose any physician and our health insurance pays for the visit .
The lack is universal pharmacare . In Ontario those over 65, most recently those under 25 and people with low incomes are covered for prescriptions with a low co pay . Our current Federal government is looking at a way to provide universal pharmacare.
2
Very complex. As for costs - of all systems - would be useful to identify -and subtract out- costs due to lifestyle factors in each. For example, if the French smoke more than Americans, or Australians drink more alcohol than Singaporians, or Swiss walk and exercise more than Germans, or Canadians eat more red meat than Brits ... etc. Such factors are probably huge. Makes these comparisons even more complex.
1
I agree...so many variables to consider!
1
Factors about United States seldom considered and that positively impact the world.
1) US dominates the world in research and development
2) US gives more money than any county to other countries for medical support and supplies.
3) no country gives more in Charity Care than the United States.
4) US Implemented single payer called Medicare decades ago and now it's bust, no money, so they are scrambling to find ways to get money to fund it. A perfect example is by fining hospitals for not reaching readmission rate goals for example.
Take note, all these systems may look great NOW, but let's see how they are doing 20,30, 40 years later. You can't keep taxing people to pay. So enough short term grades, what are the potential long-term grades? Switzerland will not stay #1 in outcomes for ever.
Be careful here nearly everything you say about America is challengeable
Of the top five pharma companies in the world Britian and Europe have three of them Much American medical research is done by American companies using their British based research divisions
I have read but cant remember statistics that America is way down the list of giving welfare support etc for countries...as for its game of sanctions sanctions etc to cripple ordinary peoples lives including medical conditions that is shameful
1
Recently had cystitis while on a 2-month stay in France. Saw a doctor within 20 minutes for 25 euros, paid @8 euros for medication. Good, quick results, very low cost. Can’t beat that.
1
I lived in Canada for six years and my two sons were born in Canadian Hospitals. While it was easy to enroll, I often waited hours in my pediatrician's waiting room, the antiquated systems made collecting the typical antibiotics an almost impossible task ($27 to park at Dr's office (not downtown), the need to climb over large concrete barriers to get into the office, the need to park the car far away from the pharmacy and wait 40 min while the doctor's handwritten prescription was filled. Also, we paid 53% of any income above $50K Canadian, about $40K US at that time to cover health care. Plus we paid 15% sales tax on "luxuries" such as dinner out, clothes, a new house, stamps, dry cleaning, movies, etc. Plus we paid for private insurance to cover dental, shared hospital rooms (not six to a ward, only two), prescriptions, vision, podiatry and many common other services. And when my son was born, they only watched the babies for four hours at night. And when I went to check on him, all the newborns were left unattended as there was only one nurse and she went on break. When I complained, I was told, "Next Time, Vote Liberal." Apparently our net 68% tax rate was insufficient to cover my health care costs for two healthy full term babies after low risk pregnancies. I had to get back to the US.
I am the author of the post above. I didn't make it clear that the high total tax rate was for both Federal and Provincial programs. So, we paid about 27% Federal Tax and about 27% Provincial (and provincial was for health care and schools.) We also paid real estate taxes and the aforementioned high GST and PST on purchased "luxuries." I had implied that we paid 53% tax for health care alone, and it wasn't just for health care. But we did pay high high taxes. Now I hear rates have come down...
Your numbers do not jive with international, unbiased figures. Studies have shown that Canadians and Americans pay about equal taxes, although in different ways. Canadians usually slight more, but some years, the tables are turned and Americans pay more taxes.
I've had three children -- one born in Europe, one born in Asia, and the last, born in New York. The best medical care was London and the worst was in New York. And it was so expensive!!!
How is U.S. ranked as innovative? The innovation does not extend beyond major hospitals while the rest of the country is operating at "cottage hospital" levels. There is no uniform standard of access to care. Add cost hurdles to access and "innovative" disappears for the wider U.S. population.
No practicing doctors were included in the panel? No women with expertise in care that often lacks data on drugs studied only in men?
2
I spend a lot of time outdoors and began to worry about some of my skin spots. I went to a dermatologist for a checkup. I was told I needed them to look at 3. I directed them to the one I was most concerned about on my lower jaw and them said I would allow them to choose the next two, since they were the experts. One thing about Americans, we sure know how to come up with business models that extract the most money for the least amount of work. Professional examinations of only three at a time with the patient responsible for identifying the three worst (in their humble opinion) I thought was a business model that dripped of criminal negligence.
2
Israel in the early 1970s had universal health care. Seldom had to wait for a physician at their office. Treatment was prompt, efficient and good. We had home visits, as well. I believe the medicine was free; if not, we paid very little for it.
Hospitals were relatively close from where we lived, excellent in the large cities.
We had solar panels on the house for electric water heaters, too, and I'm still waiting for that, as well. Long wait on both.
1
It is not clear how outcomes were determined and compared. Relative superiority in outcomes may simply represent better health habits in the population. For example, the easiest and cheapest way to improve mortality from smoking related diseases is not to smoke. A great deal of money is spent on treating conditions that result from poor life style choices.
The authors might also profit (no pun intended) from comparing the costs of pharmacy and devices (i.e. total joint prostheses) in the various countries under discussion. Forgotten in all these comparisons is the outrageous cost of medical education in the U.S.
Daniel Allan, MD, FACS
3
I lived in Switzerland for a year 2016-2017. Because I had primary hypertension (controlled with a $10 generic Rx) I was only eligible to sign up for the most restricted healthcare plan. I could not qualify for plans that offered private rooms with hospitalizations or higher-end preventative services. Also, in Switzerland dental care and eye care are not covered under any insurance plan. Frankly I don't see why the Swiss system would be preferred to the US. An article in the Zurich paper in 2016 said Switzerland was below the OECD average in quality of care and above it in cost. Did that come up in the research?
1
I resided out of the States for 25 years. The most notable difference is universal coverage. Obamacare began addressing this, but more is to be done. Healthcare costs are high here, but outcome don’t coorelate. If there were one thing needing attention it would be easy, but there there is enough blame to pass around. A combination of physicians, hospital admisitration, insurance, not mention politicians. In a country this rich, we can surely do better
Why was Italy not included? Better outcomes than in the US at roughly half the expenditure as % of national GDP. Covers everyone with modest co-pays and none at all for over-65 and some other categories.
3
Agree! We are dual citizens and have seen excellent, caring nursing home care at a fraction of the cost in the USA. Medications at cash cost (Italians pay 20% of what we pay!) are far lower than the exorbitant costs in the USA. The quality of care is quite good, it may vary between hospitals......as it does in the USA! The cost is far lower!
1
Wow! The lengths to which the compilers of this article went to in order to make the United States even arguably competitive in this comparison - indeed, to make it even arguably comparable - are essentially obscene.
“Like every country here except the U.S., (any of the other countries) has a universal health care system...” That’s the point. I say that an arrangement which does not provide universal health care is not a “health care system”.
The other countries have health care systems, the United States has a health care market - so who would be surprised that a marketplace produces more profitable activity (the medtech industry) than health care (the objective of any health care system).
In any civilised country, sick people get treatment no matter what. In America, there’s no such guarantee. It’s not sub-optimal, it’s barbaric. The current American health care market has this in common with Libya and Ancient Rome.
Health care is something that can only be assessed at an individual and personal level - as attested by virtually every comment written here. If you, yourself, you the person reading this, are sick, do you care about national statistics and percentages?
Whatever the percentage of Americans who have no access to health care, it’s 100% more than all these other countries and for any one of those Americans, the American health care system is as bad as any system that exists today or has ever existed. That’s the true, and only, measure of the American system.
7
This "so-called" competition is woefully short on actual data. Also cost per capita is a much better parameter to rate efficiency than percentage of GDP as you would expect a richer country to spend a greater percentage without necessarily being efficient.
All other industrialized countries have some form of universal government run health care, mostly single payer. They get better care as
measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as
efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Some data:
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let's compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth: UK - 81.1 US - 78.8
Infant Mortality (Deaths per 1,000): UK - 3.8 US - 6.0
Maternal Mortality (WHO): UK - 9 US - 14
As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
3
Sweden and/or Norway for me, please.
I live in France. I have relatives and friends American and Anglo; English, Irish, Canadian. A few examples, my brother, living in Oregon, working for a hospital, had eye surgery. he paid about 5000 dollars out of pocket. The Anglos are all very happy to get proper treatment for anything basically free. They never go to England or Ireland for medical, even that they can. One of my American friends living in Florida pays 600 dollars a month for 'coverage', with a 6000 dollar a year deductible,its catastrophic insurance. Coverage for my wife and I is about 140 dollars a month for the supplemental insurance. She had 'non-intrusive gall' bladder surgery, cost: Zero, zilch. She also has Rheumatoid Arthritis; a chronic disease; as such she's on 100% coverage from the Social Medical system for this disease. My brother's wife in USA also has it; they get to pay hundreds of dollars above their policy. In France, you work, you don't work, you are covered. The system functions; waiting for treatment is at a minimum, quality is world class; we run a slight deficit, going down with improving employment. Neither right or left politicians would survive if they touched the system ( our conservatives just talked about it last elections; they got booed and laughed at and also lost the elections).
Everyone in the world deserves good health care and every Western country can afford it. So, what are you waiting for America?
7
My biggest concern is that we need to keep the innovation of the U.S. going. I think we subsidize the rest of the world in that respect. I have never understood why industries that are stuck paying for retirees and employees' medical care never bought into the national model. Makes no sense to me, since it would reduce their costs enormously.
You do not subside the rest of the world in medical. Any breakthroughs in medicine coming from USA are sold to the rest of the world, not given away, Look elsewhere for your high medical costs, like the Pharmacy industry, Hospitals, very rich doctors. Nurses make so much money that men are starting to get into the profession, ok, a welcome first , but they don't do it for small pay.
2
The "we subsidize the world" is a myth. Study after study shows that US healthcare companies spend 2-3 times more on marketing and advertising than they do on R&D. They also spend 2-3 times more on executive management salaries and offer obscene bonuses relative to their worldwide counterparts. The only reason they can and do gouge Americans for the same treatment that costs less in Europe and beyond is that those countries can and do negotiate for ALL their insured citizens: in France that is over 60 million, same in Germany. Even tiny Holland buys with the clout of some 17 million patients - imagine what a prescription drug would cost if the greater NYC metropolitan area told Pfizer to drop a price or they go to the competition?
1
There is always a lot of talk about American innovation in healthcare/medical advances....Be careful here,medical advances are occurring all the time all over the advanced world,China Japan France Germany etc
Britain has a huge pharmaceutical industry and medical research industry...You may have read that Viagra was discovered by Pfizer the US drug company...That is not strictly true...Viagra was discovered by British scientists working at Pfizers huge British research division and first demonstrated there.....
Take care with the idea that it is Americans who are always the innovators...
The increasing numbers of Brits moving to France because of greater access to quality care is more telling than the "expert analyses." If you read the (quality) British press, there is story after story of NHS disasters due to substandard care, miscommunications among foreign-trained physicians and staff, and long wait times for care.
1
Granted that if you read the British press, you will hear story after story of NHS failings - having a moan being a national pastime. Take another look, however, and you will see that for the overwhelming majority of the British population, the NHS is something of which we are proud.
We want it to do better, we want to have our individual requirements met, we all think we know how it could be improved. But only the rich are happy at the thought of relinquishing the right to care, free of charge at the point of need, funded by public taxation.
1
More nonsense ! You still pay for healthcare in France although its verygood Long wait times have been drastically cut by fast tracking...cancer etc...there have been a handful of miscommunication problems and care scandals ...in a system that includes virtually ALL all UK hospital..s that can happen but the NHS is continually innovative using every high tec IT system to improve its services...it is always working to improve standards as it is continuously under critical scrutiny from all political parties.
US docs and hospitals charge more per unit of service. It's that simple.
1
Should healthcare be considered to be a basic right?
Why?
Why not?
1
The ACA was never fully implemented. 31 states finally expanded Medicaid, a vital part of the ACA. MC was never permitted to bargain with the drug companies for lower drug costs and U.S. citizens were never encouraged or allowed to buy drugs from Canada at a much lower cost. The constant attempts to repeal the ACA for political purposes impeded lower costs. The ACA got the message across that health care must be paid for and everyone will need medical insurance and everyone needs to pay. The ACA needs political support.
1
If anyone wants a ranking of health care systems around the world that is perhaps a lot more rigorous and looks at the flaws and opportunities for US healthcare there is this:
http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/
One thing that is highlighted as far as child mortality ,life expectancy and amenable mortality is that the US could make gains by investing more in measures to prevent chronic disease.
The US ranks a poor last amongst rich countries and is a significant outlier. The top three are the UK, Australia and the Netherlands.
2
I favor, at the very least, a system similar to original Medicare with a supplement, which is exactly what I have now. I can see any doctor without a referral, am covered throughout the country and overseas (due to my supplement), and use Part D of Medicare for prescriptions, though sometimes they are cheaper with a good discount card or at Costco (where the pharmacy is open to everyone).
No one should have to worry about money when they are ill. For those on the lower end of the income spectrum, there should be no co-pays or subsidized supplemental insurance.
Better yet, let's finally get with the rest of the industrialized world and provide free (paid by taxes) healthcare for all, including medications. It's the very least we can do and we will probably save money doing it.
2
Eight years ago, I had a heart attack while on vacation in Stavanger, Norway. I am an RN with almost fifty years experience primarily in emergency nursing. I recognized all the medical equipment I saw, which was equal or better than US equipment. The "emergency room" in the 700 bed hospital whrre I was taken was almost empty. When I asked the nurse where all the patients were, she said "Oh, they all go to their neighborhood clinics, to get their health care." Which means they didn't get sick enough to need emergency care. The wards were very clean and QUIET. Most patients were expected to get up and walk to the unitt dining room. Family were invited to eat there also. Meals were simple but enjoyable. I was hospitalized for five days. I got superb care. The chief Internal Medicine resident said I needed a cardiac ultrasound to evaluate my heart function, then rolled in a portable ultrasound machine, completed the scan himself, printed out a copy for me, and explained the results to me there at the bedside. When discharged, I received two discs with my coronary angiograms, and a printed hospitalization summary. When I tried to pay my bill, nobody knew how to collect any money, in spite of the fact that I had travel medical insurance. Six months later, I was notified that my insurance company had paid the hospital about $500.
The next time I have a serious medical problem, I'm going to Norway.
15
The fundamental problem with the US insurance market is that it has become another massive industrial complex. The need for profit is the main driver for every decision about coverage and costs. While Switzerland resembles Obamacare, the US companies (and the pandering Republicans) would never stand for the level of regulation. We will always be hamstrung as long as the primary motivation of the decision makers is return on shareholder value and profit.
9
Just a thought but the pharma argument that they can charge exorbitant amounts of money for drugs which they hold a monopoly on because it funds further research is perhaps a bit flawed. Yes the American system does fund research but super profits for pharma companies is not an argument for the US system in my opinion.
3
More than 50 years ago I experienced the British system when I arrived there with my 2 yr old daughter who had pneumonia. We were sent to a Harley St. doctor and charged nothing for the care or the medications! I was astonished and have held that image in mind all this time. On a trip I led in Turkey several people got sick - one went to a hospital - the charges for all the care were minor and when I lived there doing research, no charges. What is wrong with the US that it can't do better?
4
Well, coincidence, just picked up the mail and there was my 2018 insurance bill.
$1,050 a month for my wife and I with 1500 deductible (As US taxpayers, this qualifies as a high deductible plan for HSA purposes). I also got my kids COBRA bill for the US.
Switzerland is not cheap.
As a practicing physician for 50 years the following are my observation [Grant you received medical degree from a developing country. We were trained t make a diagnosis on the history and physical exam. Investigations are only to support your diagnosis. I noticed a shift everywhere in the world in that order the tests first. Let us train clinicians and not postal people referring to consultants for every little issue
-Develop facilities to reduce referral to Emergency departments for non emergency tests. This increases the cost significantly
Last but not the least-- "Insurance" is a shared responsibility. If only some contribute in to insure pool cost is going to be up [as we can never refuse a patient service because lack of insurance. The burden is shifted to the rest. Create a system that everyone pays in to the pool. There is no free lunch
6
In 1962 our son was born in the National Health System in Britain. The pre- and post natal care was excellent. My wife learned about exercises, breast feeding, was encouraged to share information with other expectant Mothers etc. Before birth the Physician came to the apt., introduced himself made an appointment, an put my wife in touch with a Mothers to be group. Everything was wonderful.
Then we came to the U.S. When our second child was to arrive the physician discouraged breast feeding, charged an expensive fee,spent little, had to be convinced to try nat. chldbirth. All 4 children were del. naturally: NHC best in UK hands down!
7
I am both an American and an EU citizen. In France, under the universal healthcare system I have access to the best in the world: hospitals, clinics, doctors, specialists, physical therapists, medicines, all testing such as MRI's and no waiting. With a flash of my Carte Vitale, the universal health card, it's taken care of. In comparison with the USA? Well, there is no comparison. The system in the USA is a cruel joke, played by the politicians and their backers who want as few as possible to know of other systems that actually support all citizens, not just the rich. American exceptionalism at work once again -- we're the outlier among nations in choosing profit over people.
14
We experienced a minor orthopedic emergency in Milan, Italy on a Sunday evening. Our hotel sent us to an emergency orthopedic hospital and we arrived about 9:30 to a full waiting room. 2 x-rays and 3 interviews with an orthopedist later we were all set. We were told there was no charge for emergencies in Italy.
We were on our way back to our hotel by 11pm having received amazing care. Upon returning to the US my husband wanted the opinion of his American doctor. The American orthopedist removed the elaborate splint put on in Italy, telling him he didn't need it. My husband now has a permanently crooked finger. Luckily it doesn't interfere with anything but clearly the Italian MD had superior knowledge.
It was an amazing experience in Italy.
8
The US wouldn't be on any list of mine because health care is chaos to pay for and figure out. Japan would be on my list. Taiwan. And of course any Western European country plus Canada. They've done the logical and effective thing. If you want to see a good TV documentary that compares good health care, do a search for: frontline sick around the world
It's an old but good program about the issues.
4
I'd look for one where there is at least one public plan offered by the government... maybe it's medicare... and people and companies could supplement that coverage. Ditto on prescription drugs...
Costs should be covered by general taxes, same as education.
LIke parks and such: you can have private parks but there are public parks... my experience is that public parks are far better, more accessible... but if you wnat to go to club med, have at it.
3
I lived in Canada for many years, and really appreciated their health care system. I had cancer during that time. I received timely care, top quality, and NO bills. The 2 biggest problems with Canada's system are firstly that there are insufficient doctors to service a nation of 36 million people, spread across a large geographic area. Canada is not densely populated, which makes it difficult to have access for every procedure in every location. In large population areas like major cities, care is timely and excellent. In rural areas and smaller cities, waiting for elective procedures is common ( although serious issues are immediately tended to), and many people cannot find a family doctor. This is important in Canada because you cant see a specialist without first seeing a Family doctor in Canada.
I love the immediate medical attention that I get in the USA. What I do not love is the rushed attitude of the doctors here. When you make an appointment here, you are very restricted in what you can discuss with the doc, per insurance rules. The insurance system is very top heavy in paperwork and confusing. I am still getting bills for surgery from two years ago, that have just been filed now. It is hard to get a grasp on what is owed, to whom, and at what time. The paperwork aspect of American health care is ridiculously complex and would be a good starting place for reform.
My perfect health system would be a combination of the two countries.
4
I lived in Ontario for three years, was eligible for an OHIP (provincial health) card, and had supplemental insurance for prescription, optical, and dental services via my employer. I had a family doctor there, saw a specialist for a minor chronic condition, and twice had to go to the local ER with urgent but not life-threatening problems. I was generally happy with the Canadian system; here are my takes on it.
Best feature: Completely seamless. Go to family doctor/specialist/hospital, present OHIP card, that's it. No bills, no co-pays.
Worst feature: Wait time, but that was primarily to get into the system in the first place.
Once I had my OHIP card, I never had difficulty getting an appointment with my doctor. Also, since I lived in a small but busy city, there were walk-in clinics available to take care of minor issues like sore throats.
My husband wasn't eligible for an OHIP card because his work required him to leave the province frequently, but my employer added him to my coverage as a subsidized benefit. Cost per month (drum roll): About $80.
Canadian hospitals make efficient use of their facilities. I once needed an MRI for a non-urgent condition.The apparatus was reserved for inpatients and more serious issues during normal working hours. So, I got a 5 AM appointment.
I also participated in a provincial screening mammography program and was thoroughly impressed. The wait time was less than a week, and I got the results (normal) by mail within 3 days.
4
A factor that's often not considered when comparing health care systems of different countries is the size of the country and how population is dispersed. Yes, access to care is better in small countries with large populations such as Britain, France and Germany. It's not so easy in Canada and Australia which are very large countries and the population is sometimes spread over vast areas that are very remote and the climate is often extreme. Delivering care in those areas is challenging and costly.
5
I was born and educated in France. Immigrating here (I'm a scientist) I found the US system awfully complicated. This was the greatest cultural shock for me. I hired an "expert" who put me in a useless plan of the kind advertised by trump and lost nearly all my savings at first illness (I was working too hard here...). I am now retired and appreciate Medicare BUT lots of doctors do not accept it! When will you guys realize like the rest of the world does that health care is a right every bit like equality under the law. Sure, a better lawyer can get you a better settlement and more money can get you superior care in France as well but results speak for themselves: life expectancy in France is 83 years, 79 in the US. As for innovation the French are doing very well thank you particularly where basic care is involved (gadgets, preventive care, self education software, medical electronics, etc). There is actually a growing medical tourism in France from the rest of Europe because of this... BTW, I kept my "carte vitale" and I do use it when I return to the old country once in a while. Vive la France!
11
life expectancy which averages everyone who dies at birth to living to an old age I wouldnt think has too much to do with having health care or not. Risky lifestyles, bad diet and environmental factors are more involved. Also the US has a tremendous amount of immigrants and diverse large population vs. France
I have experience of health care systems in the US, the UK and France. Although it has been, fortunately, a limited experience, France was a revelation to me. I walked into a local hospital, after much flimsy advice from my insurance helpline, and was seen promptly and professionally, with the necessary tests, and with a bill so low at the conclusion that, as another reader wrote, I didn't even bother to seek reimbursement. My partner had a similar experience as well.
In the UK, it's a real crap shoot as to the quality of care you'll receive and how long it will take; I often say that if you don't know what your problem is when you walk into the GP's office, you won't know much more when you walk out. I did have a good GP once, but she went back to Australia. I pay monthly to have additional private insurance for when the wait is too long.
When I visit the US, I often surprise doctors that I don't have health insurance and am paying out of pocket, thus can't afford the suggested tests, though I sometimes get pitied by the pharmacist at CVS and given a "special rate" (so I'm told). No doubt the US leads in innovation, we always have, but it doesn't do much good if patients can't afford it. But don't covet the UK system too much, unless you are happy to pay for supplemental coverage.
3
If you had something serious you would be fast tracked in the UK ...I think there was nothing much wrong with you...there have been problems in the last few years in A and E becauselarge numbers of teenagers etc have been turning up drunk or drugged and wanting treatment or etc.Britian has now copied American ^drunk tanks ^for these people I notice you paid for the French treatment but nothing for the British..I think you had little wrong with you...incidentally UK doctors do not lay on the clever talk about your condition unless you ask...they are not phonies trying to impress you as I said in an earlier comment they are there for the patient not to show off
Very interesting discussion indeed. One interesting trend was almost linear relationship between judge's verdict and reader's pole verdict for first and third matches and close contest in second, fourth, fifth, sixth & seventh (especially by readers). I wonder, was this due to positive influences of judges in the panel? More importantly, there was definite and visible positive bias by judges to highlight better dimensions of US health systems, this is reflected very well in match six (France vs. US). In this match France health systems was given narrow lead by judges (3-2) but overwhelming lead by readers (91% vs. 8%, as on Oct 27, 2017), thus breaking the trend of linear relation between judges and reader's opinion. In my opinion, in such type of discussion, having judges from different geographic reason can really helpful. The complex and inequitable health systems of US very widely debated.
4
The key word in this discussion is: "Universal". Only the U.S. lacks universal coverage as the goal if not the reality. It seems the that before we can start looking at trade-offs between "private funded" systems and "public funded" systems, we (the Citizen of the United States of America) have to agree that an system the first makes sure all citizen are covered and have access to a health services. After that we could probably look at those trade-offs in the same way we look at tax policy - who does it hurt and who does it help. Not exactly easy, but we all (most of us anyway) accept the fact taxes are a price we pay for civilization. So should universal healthcare be a price we pay for civilization.
I vote for Switzerland, because it system seems closest to what we currently have, and therefore easier to achieve.
2
I am glad you brought this up. One thing not discussed are the philisophical differences between Europe and the US. Of course the US rebelled against England and the old European king ships, so there is a natural distrust of large government and or rulers, Of course England was taken over centuries ago by the Normans who took all land and titles from the Saxons, to this day the British still bow down to the kingship and government controls. In some cases people would rather take there chances on the current system in the US than have an overlord taking care of all there health needs.
in the US, there is the "right" to elect not have carry health insurance. This is considered freedom!
In my opinion the very best an individual - without regard for others - can achieve is to work for a large employer in the US. Taking their Cadillac plan, paying for it with pretax dollars and without consideration for preexisting conditions. And, getting dental and glasses tossed in as well.
There is no question that access in the USA is excellent. I can go to a walk in clinic on a Sunday or an evening. I can get a same-day MRI. On the other hand, there is over-testing in the US. (test everything!) . I've experienced the Canadian system and watched family members wait too long for tests. And I've experienced the Swiss system where I asked a doctor to run an extra cholesterol test (easy ask in the US) and was declined.
Presently, I carry the Swiss mandatory insurance and a couple of upgrades. I was denied access to some upgrades due to preexisting conditions. Access in Switzerland is easy with the healthcard; but it is much harder to advocate for yourself or seek additional opinions as in the US.
In terms of access for everyone I like the Swiss system. Everyone gets a solid baseline at a good price and upgrades are possible covering wellness, dental, doctor choice, geography, private room, etc. In terms of immediate access to doctors, self-advocacy, and independence; I'll take the USA over everything else.
1
Minor point but Britain was among the first to rebel against the king and establish a sovereign parliamentary system. The parliamentarians of Oliver Cromwell. Obviously, a bit dated now (black rod and everything?) and the royalists did fight back but still true and the sovereignty of Parliament and democracy is still treasured.
Here is my personal take, having lived in Canada, US and France and with daughters in US and Switzerland.
(a) Switzerland: Yeah, good access, but very expensive. Daughter has high premiums, high co-pays and a high deductible so she avoids doctors. Sounds like ACA. (b) France: Good/fast access to doctors/facilities and the cost reasonable. No waiting lists. But, of course, cultural differences. French hospitals/clinics, while providing up to date service, did not seem as modern/clean as North American hospitals. All doctors in T-shirts and jeans somewhat a shock. We went cultural-two daughters born at US Hospital in Paris (thankfully covered by employer). (c) US: Quality of care outstanding. No wait times; more MRIs in a few years in Washington than my entire life elsewhere. But found US health costs expensive as hell and administratively daunting. After any procedure, bills from every conceivable health professional come months later, then fights with insurance. (d) Canada: Great administratively and good outcomes. Never see a bill. Show up with health card (looks like a drivers license) and that's it. BUT, primary doctor is gatekeeper to medical procedures or specialists, and unless urgent, wait times can be long, sometimes 4 months or more. (e) So...if I was rich and not fearful of costs now and in future-US. But, universal access, cost and administrative ease-Canada (but yeah, up our game on wait times.). And if I was French-France.
(a) Switzerland: Yeah, good access, but very expensive. Daughter has high premiums, high co-pays and a high deductible so she avoids doctors. Sounds like ACA. (b) France: Good/fast access to doctors/facilities and the cost reasonable. No waiting lists. But, of course, cultural differences. French hospitals/clinics, while providing up to date service, did not seem as modern/clean as North American hospitals. All doctors in T-shirts and jeans somewhat a shock. We went cultural-two daughters born at US Hospital in Paris (thankfully covered by employer). (c) US: Quality of care outstanding. No wait times; more MRIs in a few years in Washington than my entire life elsewhere. But found US health costs expensive as hell and administratively daunting. After any procedure, bills from every conceivable health professional come months later, then fights with insurance. (d) Canada: Great administratively and good outcomes. Never see a bill. Show up with health card (looks like a drivers license) and that's it. BUT, primary doctor is gatekeeper to medical procedures or specialists, and unless urgent, wait times can be long, sometimes 4 months or more. (e) So...if I was rich and not fearful of costs now and in future-US. But, universal access, cost and administrative ease-Canada (but yeah, up our game on wait times.). And if I was French-France.
3
A friend who is a retired nurse practitioner just waited two months for an appointment with a GI specialist in Massachusetts. There was some urgency but even so there was a long wait for a specialist after seeing her GP. I recently experienced something similar. This seems pretty standard which makes me wonder if this walk in for an MRI easy access really typifies U.S. healthcare. Wait times seem the norm here and the costs much higher than Canada or the UK.
My family and I have had first hand experience in the French delivery system.
Not being French we were not "covered" but our care was the same. Two features stood out. First the degree of attentiveness and time we received from the physicians. No one seemed rushed or pressured for the time they spent with us. Second the Hospital bill was "one bill" per diem. No extras. Food, doctors, x-rays. meds, all was completely covered in the daily cos and yet the care was highly personalized. Much different than a U.S. hospital experience.
Not being French we were not "covered" but our care was the same. Two features stood out. First the degree of attentiveness and time we received from the physicians. No one seemed rushed or pressured for the time they spent with us. Second the Hospital bill was "one bill" per diem. No extras. Food, doctors, x-rays. meds, all was completely covered in the daily cos and yet the care was highly personalized. Much different than a U.S. hospital experience.
3
Japan, where I live, has an excellent government-run system. Everyone is covered and costs are reasonable. The Japanese are very happy with it--proud of it, actually. There are no private health insurance companies to rip people off.
At age 76, I pay only 10 percent of all costs. Wonderful!
At age 76, I pay only 10 percent of all costs. Wonderful!
2
This tournament is rigged. The selection of the "final 8" competitors seems random; the judges are US-centric; the criteria include things few consumers would care about, such as political compatibility with the US; all criteria is qualitative, without any clear metrics or weighting of elements. This "tournament" would be like an NCAA tournament where 1 team gets a bye into the final 8, chooses the refs, chooses which fouls to call, and decides where the 3 point line is!
My bottom-line choice was where to retire, with my wife and I eligible to live permanently in the EU, Australia, Canada and the US. The US was the easy out. Healthcare eliminated the US: it was the only country where we had a material risk of bankruptcy, and life expectance runs years behind the rest.
My bottom-line choice was where to retire, with my wife and I eligible to live permanently in the EU, Australia, Canada and the US. The US was the easy out. Healthcare eliminated the US: it was the only country where we had a material risk of bankruptcy, and life expectance runs years behind the rest.
7
I worked in the American Health/Patient Care system for 30+ years. I prefer France. I have received better care in France that I did in America. The main differences that I see:
The American system will bankrupt a patient given the chance while providing limited care. Insurance companies decide how long a patient should spend in a hospital making those determinations based on the lowest average of expenditure based upon one diagnosis. There's seldom appropriate after-care, there is little healthy life style advice given or made available to children when it is easier to form a healthy life style before bad habits set in.
In France, I pay my monthly fee. My life style has changed. I am healthier because my doctor (doctors) will give me medicines when I need but the goal is always to get me off of medicines. Not all medications require a prescription. Since the pharmacies and doctors and hospitals have a national system it is easier to see a problem with a particular patient, as oppose to the USA where people shop Clinics, ERs, and Doctors for opioids.
My personal experience as a patient between the two, US and France, well France wins. I don't think much of US over France in regards to innovation. US isn't any further ahead anymore. After WW2 it was nearly the only country with a solid infrastructure still standing. Now all those countries which had to rebuild their infrastructures are rebuild. All innovation comes from everywhere now.
The American system will bankrupt a patient given the chance while providing limited care. Insurance companies decide how long a patient should spend in a hospital making those determinations based on the lowest average of expenditure based upon one diagnosis. There's seldom appropriate after-care, there is little healthy life style advice given or made available to children when it is easier to form a healthy life style before bad habits set in.
In France, I pay my monthly fee. My life style has changed. I am healthier because my doctor (doctors) will give me medicines when I need but the goal is always to get me off of medicines. Not all medications require a prescription. Since the pharmacies and doctors and hospitals have a national system it is easier to see a problem with a particular patient, as oppose to the USA where people shop Clinics, ERs, and Doctors for opioids.
My personal experience as a patient between the two, US and France, well France wins. I don't think much of US over France in regards to innovation. US isn't any further ahead anymore. After WW2 it was nearly the only country with a solid infrastructure still standing. Now all those countries which had to rebuild their infrastructures are rebuild. All innovation comes from everywhere now.
3
Insurance companies actually dont decide the length of care in a hospital, the hospital does. Its paid on a DRG system, this moves the risk to the hospital who will get a set payment from the Plan based off all the procedures and diagnosis codes from the event. Also , most people dont shop clinics, er's and doctors for opioids, these tend to be people on the government plans such as medicaid because other plans charge the individual for going to the ER where as the government plans dont... The innovation discussed is talking about technology and pharmacy not stuff built after ww2.
This article's title is misleading. The judging is not on which is the best system, but rather which is the best system for the US. That's fine as NY times is American, but still the misleading title cause the reader to misjudge some of the countries' systems. E.g, in the France-Australia comparison, one of the judges says that France's system is better because the Australian public hospital system would not work in the US because public hospitals are and would be underfunded in US.
No complaint with the French system, but this hides that another aspect of the Australian system makes it a model for the US . In a major way it is closest to the US system because it is a meld of public and private insurance. It works better, however, because the private coverage sits on top of the pubic insurance rather than one or the other as in the US.
While the authors approach is sorely needed to get past the dominant not-invented-here attitude of Americans toward foreign systems, the authors still display a less than full understanding of the foreign systems. Perhaps this could be cured by splitting the analysis and comparisons into two parts: one scoring the various system in absolute terms and only after that injecting factors of how much a given system would or would not work in the US.
No complaint with the French system, but this hides that another aspect of the Australian system makes it a model for the US . In a major way it is closest to the US system because it is a meld of public and private insurance. It works better, however, because the private coverage sits on top of the pubic insurance rather than one or the other as in the US.
While the authors approach is sorely needed to get past the dominant not-invented-here attitude of Americans toward foreign systems, the authors still display a less than full understanding of the foreign systems. Perhaps this could be cured by splitting the analysis and comparisons into two parts: one scoring the various system in absolute terms and only after that injecting factors of how much a given system would or would not work in the US.
4
I think one can take it as pretty much axiomatic by now, that on any social issue, the US is the most regressive, most inhuman, most cruel, most stupid. The rest of the first world has figured out how to balance human needs with a modern economy, but we seem to be destined to be sacrificed on the alter of the "free market" religion.
7
Israel should be included in the next study not only from a cost basis to gov't and citizens,the, but because of leading technological advances in research,procedures and devices.
Israel is also one of the first and best teams to travel worldwide in areas devastated by disasters such as natural and epidemics.
Israel is also one of the first and best teams to travel worldwide in areas devastated by disasters such as natural and epidemics.
3
I choose Cuba.
2
Japan and Scandinavian countries should be included next trial
1
I've lived in both the UK and Australia, choice for standard physician treatments is better in Australia, but at a cost. While most physican visits are in theory refundable in practice there's a $40 to $50 gap, which is not claimable on private insurance.
For hospital treatments, access is better in Australia if you're a private patient, but there is quite a bit of overcharging my wife got the surgeon she wanted at the cost we knew, but the nominated anaethetist overcharged. Access to hospital treatment via both the public system in Australia and the NHS seems about the same.
Upshot? If you can pay for private insurance access is better in Australia, and there are more hidden costs than the UK, but both systems will fix you and if you can't pay or don't have insurance and there's a decent universal safety net.
For hospital treatments, access is better in Australia if you're a private patient, but there is quite a bit of overcharging my wife got the surgeon she wanted at the cost we knew, but the nominated anaethetist overcharged. Access to hospital treatment via both the public system in Australia and the NHS seems about the same.
Upshot? If you can pay for private insurance access is better in Australia, and there are more hidden costs than the UK, but both systems will fix you and if you can't pay or don't have insurance and there's a decent universal safety net.
2
What is the point of comparing the private health insurance system you used in Australia with the British/
Its the totally free NHS we are talking about here
I'm surprised to not see Sweden included in this example. It is my opinion (after living in the UK and feeling the strain of our national health service), that the Swedish system is in fact significantly better, and also a free at point of service system.
I'd be interested to see how you would compare Sweden to the countries you have already compared. Some say the Nordic model is one of the most effective in terms of looking after individuals, and it doesn't seem to be represented here at all. Shame.
I'd be interested to see how you would compare Sweden to the countries you have already compared. Some say the Nordic model is one of the most effective in terms of looking after individuals, and it doesn't seem to be represented here at all. Shame.
2
ANY of the other systems is better than any US system to date. Healthcare should be as accessible as an elementary school education.
Our Canadian system works pretty well. My complaint about it is that wait times for elective procedures (like knee replacements or cataract surgery) can be long. Even some "just checking" diagnostic tests, like MRI's and colonoscopies, can take months to get scheduled. I have said for years, I would happily pay a bit more in taxes in order to shorten those wait times for all. Right now, per capita, healthcare spending in Canada is about half what it is in the USA, so a good universal system will not bankrupt you.
Whatever system you decide on, for it to work well for all, logic dictates (Spock is my favourite Star Trek character) it must:
1- include mandatory pre-existing condition coverage - period - no option. The young and healthy may think they do not need it or want. They may balk at helping to pay for their grandparent's bypass surgery. The young need to listen to Billy Joel's "Somewhere Along the Line", and realize that they one day will be that "Old and feeble man".
2 - include mandatory participation - period. Everyone needs to be enrolled so that costs are spread over the widest possible base, and premiums are thus kept as low as possible.
3 - have a premium structure that ignores risk factors such as age or pre-existing conditions. Otherwise, those that need the coverage the most will not be able to afford it.
Have a heart!
Our Canadian system works pretty well. My complaint about it is that wait times for elective procedures (like knee replacements or cataract surgery) can be long. Even some "just checking" diagnostic tests, like MRI's and colonoscopies, can take months to get scheduled. I have said for years, I would happily pay a bit more in taxes in order to shorten those wait times for all. Right now, per capita, healthcare spending in Canada is about half what it is in the USA, so a good universal system will not bankrupt you.
Whatever system you decide on, for it to work well for all, logic dictates (Spock is my favourite Star Trek character) it must:
1- include mandatory pre-existing condition coverage - period - no option. The young and healthy may think they do not need it or want. They may balk at helping to pay for their grandparent's bypass surgery. The young need to listen to Billy Joel's "Somewhere Along the Line", and realize that they one day will be that "Old and feeble man".
2 - include mandatory participation - period. Everyone needs to be enrolled so that costs are spread over the widest possible base, and premiums are thus kept as low as possible.
3 - have a premium structure that ignores risk factors such as age or pre-existing conditions. Otherwise, those that need the coverage the most will not be able to afford it.
Have a heart!
5
In the US we already have 80% of the population covered with plans that dont ask about pre existing conditions, you know what they are ??
Medicare, Medicaid, ACA and Company Sponsored. none of these set ups ask for your condition, maybe just age and how many dependents.
1
I have to be skeptical of the Swiss example because in my understanding Switzerland has a much less diverse population than the American or other European countries.
1
I have been living in United States for 5 years, and Canada for 4 years, as an international student. When I was studying in US, I have to pay mandatory health insurance for about $2,500 per year. I had elbow fraction and needed MRI when I was in US, and I was being told that my medical insurance would not cover the MRI and CT scanning. I had to spend $600 for my MRI.
And then I went to Canada for my master degree. I only need to pay $700 medical insurance per year from private provide, and I was able to receive provincial health card once I stayed in the province for a year. I was diagnosed with hyperthyroid and needed regular blood check. My provincial health insurance covered all my expenses. Right now I am working in Canada as a permanent resident and I am pretty happy with my company health insurance.
And then I went to Canada for my master degree. I only need to pay $700 medical insurance per year from private provide, and I was able to receive provincial health card once I stayed in the province for a year. I was diagnosed with hyperthyroid and needed regular blood check. My provincial health insurance covered all my expenses. Right now I am working in Canada as a permanent resident and I am pretty happy with my company health insurance.
4
I have a house in the USA and one in France. The French healthcare is fantastic and CHEAP compared to the USA. The care received is very similar to the USA in regards to health outcomes from my observations. BUT, everyone knows how much it will cost to see the doctor. If you need an MRI, you know the price.
An American (but with French health care privileges) living in my village was recently involved in an accident requiring an ambulance, surgery for a broken elbow, a hospital stay and rehab. Total cost, $150. She was told, when she asked, the cost of all services.
My elderly neighbor needed surgery for a cancerous tumor. Since she (along with many in my village) own no vehicle, a traveling blood draw unit was dispatched to her house for pre-op bloodwork. No extra cost to her.
On the day of surgery, early in the morning, a special medical taxi picked her up to take her to the hospital. She was allowed to have a support person ride as well. They will bring her back home upon discharge. This was no cost to her.
Our village doctor makes house calls when appropriate. The pharmacy will deliver prescriptions. No charge.
People here don't worry about health care here. I've never heard it discussed unless I initiated the conversation. I find it very caring and comprehensive and certainly no one I talked to fears losing their house if they become ill.
An American (but with French health care privileges) living in my village was recently involved in an accident requiring an ambulance, surgery for a broken elbow, a hospital stay and rehab. Total cost, $150. She was told, when she asked, the cost of all services.
My elderly neighbor needed surgery for a cancerous tumor. Since she (along with many in my village) own no vehicle, a traveling blood draw unit was dispatched to her house for pre-op bloodwork. No extra cost to her.
On the day of surgery, early in the morning, a special medical taxi picked her up to take her to the hospital. She was allowed to have a support person ride as well. They will bring her back home upon discharge. This was no cost to her.
Our village doctor makes house calls when appropriate. The pharmacy will deliver prescriptions. No charge.
People here don't worry about health care here. I've never heard it discussed unless I initiated the conversation. I find it very caring and comprehensive and certainly no one I talked to fears losing their house if they become ill.
12
What a joke that the U.S. Healthsystem was picked by your biased U.S. panel to go to the 2nd round & still get two votes. You chose the poorest nation in Singapore, as the first competitor.
I lived 17 years in the USA & your system is only good if a person has a good job with coverage. It can't even come close to touching the social health systems of Canada, Britain, France, Germany etc...
The U.S. Health System is 10 times more expensive than the Canadian system per capita. Your drugs are also considerably more expensive.
When I lived in the U.S., I got bladder cancer & the insurance companies refused to cover me, or my family, because I had cancer. We lost all of our savings paying for medical expenses and we had to use our RRSP's, which killed us in taxes. I recently had many tests done in Ontario, Canada, for a number of issues. I had a biopsy, a Cysto for the bladder cancer. I had a brain MRI (continuous Virtigo); Kidney test; heart stress tests and a Nuclear test and a Colonoscopy. All of this was done in a timely manner and it did not cost a cent. Also my Asthma medicine is now free because I just turned 65. If I were still living in the U.S., I could not have afforded even half of these tests. I would probably be dead by now and my family would be broke.
If you want to write this kind of article, you need to have an international panel that represents all of these countries, so that your results are not biased and quite frankly a joke.
I lived 17 years in the USA & your system is only good if a person has a good job with coverage. It can't even come close to touching the social health systems of Canada, Britain, France, Germany etc...
The U.S. Health System is 10 times more expensive than the Canadian system per capita. Your drugs are also considerably more expensive.
When I lived in the U.S., I got bladder cancer & the insurance companies refused to cover me, or my family, because I had cancer. We lost all of our savings paying for medical expenses and we had to use our RRSP's, which killed us in taxes. I recently had many tests done in Ontario, Canada, for a number of issues. I had a biopsy, a Cysto for the bladder cancer. I had a brain MRI (continuous Virtigo); Kidney test; heart stress tests and a Nuclear test and a Colonoscopy. All of this was done in a timely manner and it did not cost a cent. Also my Asthma medicine is now free because I just turned 65. If I were still living in the U.S., I could not have afforded even half of these tests. I would probably be dead by now and my family would be broke.
If you want to write this kind of article, you need to have an international panel that represents all of these countries, so that your results are not biased and quite frankly a joke.
7
Once you have properly administered, well socialised healthcare, you will be astonished and delighted at the strain it takes off citizens. I am constantly pleased by the way our services are greeted by American guests; how easy, how cheap, how kindly the whole thing is. A HIV positive friend of mine just walked into a local hospital with what has turned out to be pneumonia. He has been kept in for observation for a week while they run bloodtests and make sure he is all right, he is currently on medication and fluids and is recovering quickly. All this is free at the point of entry.
Now we do have some - how shall we put this - entrepeneurial spirits - who would rather not pay for anyone else's health care. Indeed, it took over 20 attempts to get this through parliament back in the late 40s, with notably the conservative party objecting, along with private medical practitioners. The claim was made that this would lead us down the path to 'National Socialism,' as in Hitler's vision. Well, here we are, with the NHS being the most beloved and relied upon institution in British life, and not a nazi in sight.
Now we do have some - how shall we put this - entrepeneurial spirits - who would rather not pay for anyone else's health care. Indeed, it took over 20 attempts to get this through parliament back in the late 40s, with notably the conservative party objecting, along with private medical practitioners. The claim was made that this would lead us down the path to 'National Socialism,' as in Hitler's vision. Well, here we are, with the NHS being the most beloved and relied upon institution in British life, and not a nazi in sight.
4
British also have a king that owns all your land. Normans took it over and the kings took land and title from the saxons. The government just took their place.
They are used to having everyone the same and less individuality. Americans have a different social and economic view.
As a US citizen physician practicing in Japan, I would have to give one vote to Japan. The system is feeling some strain from the aging population, but everyone is covered, access is good, administrative costs are low. There are limits to yearly out of pocket costs, so no bankruptcies due to health care bills. Physician income is not on the level of the US, but reasonable, although one must see many patients to run a practice.
1
Wait times for many (almost all, it seems) are very long in Alberta, where I live. These include cancer diagnosis and testing procedures as well as surgeries and other therapies. It was exciting to read about the Swiss and French public health care models, and how they operate so much better. Unfortunately in Canada, anytime any politician tries to talk about health care reform or improvement, they set off a public backlash. 90 percent of Canadians seem to believe (on no evidence that I can see) that our system is the best and is absolutely off limits to change. Sad.
2
L.Snicket, the "sad" ending sounded very Trump like. I can't speak for Alberta; but the Ontario system is much better than what you describe and far better than the USA's system.
1
You may notice that your Alberta heath system was managed by conservative leadership for the last 40 years.
I've heard it's pretty bad there, but it doesn't seem like, until recently, anyone really cared about changing anything.
I've heard it's pretty bad there, but it doesn't seem like, until recently, anyone really cared about changing anything.
1
After living in England for 3 years and Paris for 2, I dreaded returning to the US for 3 reasons, among them the high cost of health insurance. (The others were child care and lack of good public transportation.) England's system was humane and efficient. When I gave birth to my son, the NHS offered no frills but adequate service made especially comfortable by the midwives in attendance. The community clinics were staffed with doctors who were caring and knew the family. And as a new mum, I had house calls from a clinic nurse to check up on the baby! In Paris, when my daughter broke her elbow, the care she received was immediate and excellent. In both places I think there was much more a sense of being part of a community (even for me as a foreigner). I know there are cost and outcomes considerations and I appreciate the excellent care I receive here, but our system is too complex, unequal, and expensive. WHY can't we move forward with one of these excellent models???
8
I understand people think innovation is wonderful, no matter if it is in computers, medicine, or ... However given the outcomes from medical care in the US maybe we don't need so much or we need to pay for it so it is not the under or uninsured that pay the highest price - frequently through death. No matter what we need to do a better job of delivering what has already been innovated.
We need to realize that all Republican Senators think too many people are getting healthcare in the US. It is clear to me they are not representing the under or uninsured, or those who will loose their insurance when they loose their job for any reason. They don't represent me, my friends, or anyone I know. How about you?
We need to realize that all Republican Senators think too many people are getting healthcare in the US. It is clear to me they are not representing the under or uninsured, or those who will loose their insurance when they loose their job for any reason. They don't represent me, my friends, or anyone I know. How about you?
2
There was an excellent article by Steven Woolf pubished a few years ago that made the same point you are making. The US spends lots on medical research on new treatments but more people would benefit if they simply had access to standard care today.
"We spend far more money on inventing new treatments than on research into how to deliver them... A recent analysis by our research team at Virginia Commonwealth University demonstrated that developing new treatments often does less good than ensuring the delivery of older drugs to all those in need...
"I am not advocating that medical advances be abandoned in favor of system solutions -- both are vital. But our leaders do need to find a new equilibrium between investing in new treatments and investing in delivering them. Politicians who neglect the unraveling of the health care system are missing Americans' rising frustration and anger with doctors, hospitals and insurance companies."
http://www.washingtonpost.com/wp-dyn/content/article/2006/01/06/AR200601...
"We spend far more money on inventing new treatments than on research into how to deliver them... A recent analysis by our research team at Virginia Commonwealth University demonstrated that developing new treatments often does less good than ensuring the delivery of older drugs to all those in need...
"I am not advocating that medical advances be abandoned in favor of system solutions -- both are vital. But our leaders do need to find a new equilibrium between investing in new treatments and investing in delivering them. Politicians who neglect the unraveling of the health care system are missing Americans' rising frustration and anger with doctors, hospitals and insurance companies."
http://www.washingtonpost.com/wp-dyn/content/article/2006/01/06/AR200601...
1
First of all, thank you to the NY Times for doing this research and getting feedback from people all over the world. Our politicians operate in a vacuum and that is why we are getting nowhere trying to improve our health care system!
How about this idea: Any health care system approved by US politicians for the rest of us should be used by politicians themselves. If they have to eat their own cooking then maybe we would get a fair system.
I agree with Arthur that the US is selfish and money grubbing, and we allow our corporations to rule Washington when it comes to health care. If we could just focus on government for ALL PEOPLE, then this would have been fixed years ago.
How about this idea: Any health care system approved by US politicians for the rest of us should be used by politicians themselves. If they have to eat their own cooking then maybe we would get a fair system.
I agree with Arthur that the US is selfish and money grubbing, and we allow our corporations to rule Washington when it comes to health care. If we could just focus on government for ALL PEOPLE, then this would have been fixed years ago.
3
When I was studying in Germany in 1994, while I was walking I was struck by a bicycle and propelled forward landing on my head. I spent five weeks in the Unfall Klinik in Murnau in the foothills of the Alps where I had excellent care. The membrane covering the brain had been torn, which couldn't be repaired for some time because I had a sinus infection which was treated with antibiotics. After that was done, specialists met in a conference room in the hall where I was a patient to determine what kind of surgery I needed. A few minutes after this meeting, one of the doctors came to my room to explain the surgery procedure that would be done. As a preventive measure to avoid infection, I was lying on a kind of table that passed through a window of some sort and into the operating room. When I woke up in my room there was a tube in my skull relieving pressure. The next day a physical therapist worked with me and made sure I was up and about, not only walking but working with a large exercise ball. This therapy continued throughout the remainder of my stay. About five years later the tube in skull procedure was touted on the local news in St. Louis as groundbreaking. For this reason, I don't believe the U.S. claims that we're more innovative than other countries. My daughter and her family have lived in Germany for eight years now where they receive excellent care at very low costs.
4
I was disappointed that there were no women on the panel, and that women's health care was not discussed at all. Almost anything is better than what we have under unbridled market-driven costs. The ACA disappointed largely because it benefited for profit insurance companies and big pharmaceuticals. We need cost containment first and foremost, then a single payer system would not cost "the government" ie taxpayers so much. Demand has only increased the costs, so the "market" is not a solution.
5
I thought exactly the same thing. This effort is really tainted for me. Too bad.
1
I rate France very highly because of choice , speed , cost . availability , non political management and the way it reaches right down within society equitably .
3
Last summer I visited a French family I have known for years. One of their daughters was born with a birth defect that could have led to brain damage and/or death. It's very rare, but she's fine now and starting college this year. When she was born their first thought was, who is the best doctor to see for this condition? Fortunately they have relatives who work in medicine in France and they quickly found this information and got their daughter to this doctor.
Because the condition is so rare they have found a community of other parents around the world whose children had the same condition. What was the first thought of American parents in the same situation? It was: How are we going to pay for this? Not, how can we save our child's life and make sure she receives the best care, but how can we possibly pay the bills?
They said there may be a lot wrong with the French health care system but they never had to worry about how to pay for the needed care.
Maybe Donald Trump and a few billionaires in the USA don't have to worry about that kind of thing but everyone else does. Trump and the Republican Congress are out to make sure that that kind of heart ache and agony becomes more commonplace.
Because the condition is so rare they have found a community of other parents around the world whose children had the same condition. What was the first thought of American parents in the same situation? It was: How are we going to pay for this? Not, how can we save our child's life and make sure she receives the best care, but how can we possibly pay the bills?
They said there may be a lot wrong with the French health care system but they never had to worry about how to pay for the needed care.
Maybe Donald Trump and a few billionaires in the USA don't have to worry about that kind of thing but everyone else does. Trump and the Republican Congress are out to make sure that that kind of heart ache and agony becomes more commonplace.
7
Too bad you didn't include Denmark. Two weeks ago I bought my excellent hearing aids there for over $3000 less than in the USA. Every Dane has health care. They pay a lot of taxes and they get a lot from them. They do not finance walls between countries or wars all over the world.
9
Too bad you didn't include Sweden in your analysis, this system outranks all of the above. You live in Sweden, you're insured, financed by the taxes. No private interests trying to make benefits on behalf of sick people.
I'm Swedish, living in Switzerland and I miss our Swedish system every day. Switzerland's got a three speed system (common, semi-private and private) which makes it very difficult (read, expensive) to foresee capacity in the hospitals.
If you have modest income, the health insurance can take more that 25 % of your income before taxes, and you still have to pay 10 % of the care out of your pocket.
Furthermore, the companies don't pay for all, only to a certain amount, negotiated with each Canton, the rest must be paid by the Canton, hence by taxes.
And so on..
I'm Swedish, living in Switzerland and I miss our Swedish system every day. Switzerland's got a three speed system (common, semi-private and private) which makes it very difficult (read, expensive) to foresee capacity in the hospitals.
If you have modest income, the health insurance can take more that 25 % of your income before taxes, and you still have to pay 10 % of the care out of your pocket.
Furthermore, the companies don't pay for all, only to a certain amount, negotiated with each Canton, the rest must be paid by the Canton, hence by taxes.
And so on..
4
I appreciate the analysis-I share what I believe is a fundamental tenet of most of the countries -everyone should be provided accessible, effective and affordable health care including those with no means to provide for themselves. I accept the assessment of our Canadian system but would stress that it is the wait times that drag our rankings down but the fact that it is primarily for optional surgery is not adequately stressed. Surely waiting a day or two to see your GP is not a big deal. I have had surgery for tongue.lymphatic cancer, defibrillator implant, and on going treatment for ulcerative colitis and psoriatic arthritis. Waiting to have these issues dealt with has never been a problem and today I am 75 and relatively healthy. I have paid nothing out of pocket for any of the care except for monthly payroll-pension deductions which are less than $100 per month but how much less I do not know. I subscribe to private plans for dental care and as a senior receive basically free drugs.The key to all of this is that I have received excellent care over my lifetime and have never worried about paying for my medical needs and take pride in knowing that all others in my country are similarly provided for. Worrying about your health is enough to worry about-who needs to worry about paying for it at the risk of going broke doing so.
3
I want a system where I don't have to worry that the doctor has any vested interest in a treatment or in not treating. I want the payer not to be involved in the diagnosis or treatment. Is that too much to ask?
As a young, healthy person I had experiences in both Britain and Canada. Not to say these are representative, but the Canadian doctor did not diagnose a case of Hep A. The British doctor was easy to access and I felt cared for. It seems that the readers would prefer France's system. I'd agree. What almost all of us can conclude is that we have maybe the worst of all systems.
As a young, healthy person I had experiences in both Britain and Canada. Not to say these are representative, but the Canadian doctor did not diagnose a case of Hep A. The British doctor was easy to access and I felt cared for. It seems that the readers would prefer France's system. I'd agree. What almost all of us can conclude is that we have maybe the worst of all systems.
2
The us doesn't have a system, just thousands of players going in their own direction.
Innovation is a separate matter and depends a lot on cash available.
The high cost in the us is everyone's fault. Doctors, patients, business, national mentality etc.
Innovation is a separate matter and depends a lot on cash available.
The high cost in the us is everyone's fault. Doctors, patients, business, national mentality etc.
I'm from Wisconsin, but I have lived in Australia for more than 30 years. Australia's health care system is not perfect, but it has tremendous advantages over the current US model. People aren't afraid of bankruptcy from health care costs when they get sick here. They're not afraid of losing their health care if they lose a job. No child has ever been turned away from an emergency room because of their HMO status. The people I know with complex chronic diseases can get free treatment, and are even able to get private extras insurance at a reasonable price. And, as someone who works in healthcare, I give preventative treatments (e.g. debriding callus on a diabetic foot) to many patients who just wouldn't have the money to see a clinician at all until there was an emergency (e.g. foot ulcer that won't heal due to diabetic changes to the circulatory system). Free access to preventative care improves their health and ends up costing the whole of society less in the long run (e.g. less lower limb amputations). Single payer has many, many social benefits, and Australia's system is also very cost effective - we get triple the bang for our buck that the US does. It just goes to show that good health, respect for all and fiscal responsibility really can go together.
3
It seemed to me that panelists had a little more information & insight than presented in the overviews. It would be helpful to have a rating table (like season rankings & performance data?) as to the primary attribute comparisons. My choices would utilitarian: population-wide outcomes by overall expenditures.
As a resident of France for 7 years, from 2003-2010, I had only excellent experiences with the health system there. Short waiting times for appointments: ("Would you like to come i today or tomorrow?" was the usual response. Dentistry and ophthalmology are covered, including implants (to replace a tooth whose root was broken by an incompetent US endodontist). Prices were less. The insurers use a universal form, so there is no back office of dozens of assistants to wrangle with insurers, code things, and do billing. Patents pay on the spot usually, but the fees are really low compared to in the US because they are not supporting the huge support staff.
There is less problem with privacy because patients are expected to maintain their own medical records. Labs are separate from doctors' offices; you go there for whatever you need, then return to pick up your results. The Lab will send a copy to your doctor if you want, or else you can do that. In any case, the report is yours, as are your x-Rays or MRIs or CT scans or bone density scans mammograms you get at your local radiology lab. Lab tests come with an explanation of what is a normal range for everything tested, and how yours compares.
There is less problem with privacy because patients are expected to maintain their own medical records. Labs are separate from doctors' offices; you go there for whatever you need, then return to pick up your results. The Lab will send a copy to your doctor if you want, or else you can do that. In any case, the report is yours, as are your x-Rays or MRIs or CT scans or bone density scans mammograms you get at your local radiology lab. Lab tests come with an explanation of what is a normal range for everything tested, and how yours compares.
3
I live in France and our experience has been the same as yours. We've lived in Britain and Ireland and there is no contest between them and France. Ireland is better than Britain but much more expensive. A fried of mine was in great pain and the time between going to see her general practioner and having a hip replacement was just over a week, unheard of in Britain where waiting lists are long even just a doctor's appointment can be up to a week.
I've lived in Canada (4 yrs), the UK (2 yrs), the US (27 yrs), and also lived for shorter periods in Germany (6 mos) and Switzerland (6 mos). I have a chronic illness, MS, so I have seen each system when it's stressed.
I am against single payer systems like Canada/UK. The quality of care for people with chronic, not immediately life threatening is dismal. In the UK, I had a 7 month wait to get medicine & see a MS specialist. Up to 2013 a mere 20% of people with MS were treated in the UK. Now that number is up to 40%. But France, Germany, the US, Switzerland all have treatment rates ~80%. I personally like the Swiss system the best. The quality is amazing, and while it is more expensive, you have a lot of choice in your doctor which can be vital for complex conditions. My experience in Germany was good, but not as great as Switzerland. The US has amazing care if you have insurance. Until the ACA/Obamacare was passed I lived in fear that I wouldn't be able to have coverage if I lost my job etc. If we improve the ACA, we could approach Switzerland. But the ACA didn't implement enough regulation or cost reduction which is what now needs to happen (a current political impossibility). I think people forget the ACA really just set out to increase access, but did little to address cost. Without that, it will fail long term, so let's fix that.
Also we need to be honest about the reality of tradeoffs in healthcare. There is cost, access, and quality. You get to choose 2 of the 3.
I am against single payer systems like Canada/UK. The quality of care for people with chronic, not immediately life threatening is dismal. In the UK, I had a 7 month wait to get medicine & see a MS specialist. Up to 2013 a mere 20% of people with MS were treated in the UK. Now that number is up to 40%. But France, Germany, the US, Switzerland all have treatment rates ~80%. I personally like the Swiss system the best. The quality is amazing, and while it is more expensive, you have a lot of choice in your doctor which can be vital for complex conditions. My experience in Germany was good, but not as great as Switzerland. The US has amazing care if you have insurance. Until the ACA/Obamacare was passed I lived in fear that I wouldn't be able to have coverage if I lost my job etc. If we improve the ACA, we could approach Switzerland. But the ACA didn't implement enough regulation or cost reduction which is what now needs to happen (a current political impossibility). I think people forget the ACA really just set out to increase access, but did little to address cost. Without that, it will fail long term, so let's fix that.
Also we need to be honest about the reality of tradeoffs in healthcare. There is cost, access, and quality. You get to choose 2 of the 3.
2
I have lived in both France and Australia as an international student so am able to comment on these. Both provide comparably good levels of healthcare with accessible, well qualified GPs.
However France's is a lot more affordable. In both cases you need to buy private health cover to be fully protected. But where France reimburses your health costs at 80-90%, Australia's way of operating is a lot more confusing. Your private health insurer will typically have a lot of 'opt-outs' when it comes to covering your claims. I found for instance that upon visiting a GP, my insurer would refund not even 50% of my claim.
Considering that doctor fees are already much higher in Australia, that makes the situation even worse. You are paying into a health insurance cover that has a very poor refund rate for your expenses. I was lucky to be in good health, not requiring frequent treatment. But stuff like regular dental check-ups seem impossible to perform in Australia... which is ultimately against recommended guidelines.
Bear in mind that I was living in both countries as an expat and that my level of cover would differ from that enjoyed from Australian born citizens. I totally understand that, it is not the duty of the Australian state to fund my treatment. What annoyed me was having to pay for private health insurance which covered next to nothing.
However France's is a lot more affordable. In both cases you need to buy private health cover to be fully protected. But where France reimburses your health costs at 80-90%, Australia's way of operating is a lot more confusing. Your private health insurer will typically have a lot of 'opt-outs' when it comes to covering your claims. I found for instance that upon visiting a GP, my insurer would refund not even 50% of my claim.
Considering that doctor fees are already much higher in Australia, that makes the situation even worse. You are paying into a health insurance cover that has a very poor refund rate for your expenses. I was lucky to be in good health, not requiring frequent treatment. But stuff like regular dental check-ups seem impossible to perform in Australia... which is ultimately against recommended guidelines.
Bear in mind that I was living in both countries as an expat and that my level of cover would differ from that enjoyed from Australian born citizens. I totally understand that, it is not the duty of the Australian state to fund my treatment. What annoyed me was having to pay for private health insurance which covered next to nothing.
An addendum to my previous about France: When my 2-year old granddaughter burned herself badly by spilling a cup of hot tea on herself, we took her to Hôpital Armand Trousseau, a children's hospital in Paris with a pediatric burn unit. My granddaughter, a visiting American citizen, was seen immediately with no questions asked about insurance She saw a pediatric burn specialist, went back to have her bandages changed three times, seeing the specialist once more. Her prescriptions cost a total of 5 euros at the pharmacy. When I went to pay I expected to have to mortgage my house, but the total for all visits and care was $143 euros. And this for a child not even a French citizen.
3
My wife fell ill while we were vacationing in London in the summer of 2015. She suffered a stroke and then extended cardiac arrest which almost shut down all major organs. She spent 3 1/2 weeks in the critical care ward at Charing Cross Hospital. The care was extraordinary and the compassion of the doctors and nurses unending. Each patient had her own nurse. She was never seen by a resident, only senior physicians. After they made their rounds they would seek us out to explain her condition to the family and plans for the day. No mystification. The family's support was welcomed. With extraordinarily artful, meticulous care, they restored all my wife's functions to the point that we could return her to the US by air ambulance.
She was brought to Hackensack Hospital near our home. The contrast could not be more stark: We felt we had returned her to a zoo. Providers entering the room without explanation. There was no coordination. Requests from the family went unmet. We were treated as obstacles and not welcomed as part of the support as we were in London. The care seemed at times unnecessary and irrational.The chaos amplified our anxiety. The underlying cause was pancreatic cancer and my wife died in a hospice ten days after her stay in Hackensack. And though it was a time of greatest anguish a sole source of comfort was the extraordinary care she received, not in this country,but by the good doctors and nurses at Charing Cross. We have much to learn.
She was brought to Hackensack Hospital near our home. The contrast could not be more stark: We felt we had returned her to a zoo. Providers entering the room without explanation. There was no coordination. Requests from the family went unmet. We were treated as obstacles and not welcomed as part of the support as we were in London. The care seemed at times unnecessary and irrational.The chaos amplified our anxiety. The underlying cause was pancreatic cancer and my wife died in a hospice ten days after her stay in Hackensack. And though it was a time of greatest anguish a sole source of comfort was the extraordinary care she received, not in this country,but by the good doctors and nurses at Charing Cross. We have much to learn.
3
I don't feel that I have enough information for most of these. For instance, what is the relative tax cost for citizens when it say that medical care is paid for out of taxes? Some countries have supplemental insurance purchased through employers, but what about the unemployed or retired folks? When the system in France provides between 70 & 80% of costs and the rest is out of pocket, how do those costs match up in raw $ with US insurance where the standard is 20% out of pocket, i.e., it seems like more out of pocket at least sometimes in France.
As an American living in Switzerland, I can attest to the quality and efficiency of the health care system here. Prices are not cheap (this is Switzerland after all) but I can sleep at night knowing that if a health catastrophe were to hit, even if I lost my job, my health and the health of my family would be covered.
Here, one must buy the basic (subsidized) insurance but for those who have more means, additional extra plans are available which give the benefits of private rooms, more choice of doctors, reimbursement of some extra non essential health care costs (such as gym memberships, thermal baths, etc)
My biggest wish for America would be that our lawmakers would worry less about the political victory of seeing Obamacare fail than improving the parts of the ACA that need improvement. The ACA could work, as Switzerland proves quite well.
Here, one must buy the basic (subsidized) insurance but for those who have more means, additional extra plans are available which give the benefits of private rooms, more choice of doctors, reimbursement of some extra non essential health care costs (such as gym memberships, thermal baths, etc)
My biggest wish for America would be that our lawmakers would worry less about the political victory of seeing Obamacare fail than improving the parts of the ACA that need improvement. The ACA could work, as Switzerland proves quite well.
2
The innovativeness of the US system seems to be taken on faith here, but studies show that while the US innovates more because it is a country of 320 million people compared to countries of 60-80 million people. Per citizen the US innovates less than places like the UK, etc. The US spends more money on research per person, but spends more money in every aspect of health care, without improving results.
2
I have the following priorities:
1. We need an equitable system, covering all, according to their means.
2. I realize that Douthat is concerned about how universal health care might affect people working or employment opportunities, and he fears that some may choose to get health coverage for free but then simply choose not to work to pay for this nationally by his/her labor. One solution would be to consider allowing a person to work by volunteering for legitimate, apolitical nonprofits that provide community benefit other than merely to their own ethnic or religious group.
3. Given our national opioid problem and how many states are approving marijuana, beyond medical needs, I am concerned about how this system of physicians approving pharmaceuticals and many who wish to enjoy drugs beyond any specific medical need, may exacerbate our national problems.
4. I think that it is extremely important that another goal of universal health care must be continually analyzing Big Data from all hospitals and patients to improve the effectiveness of our medical systems. This is something that Kaiser Permanente and Hospitals has done superbly for many years, together with the Kaiser medical news group.
5. Emphasis on Preventive Care. This combined with a large emphasis on natural/seasonal foods and preparation will be very important.
6. New technologies and innovation should help many but especially the very young and elders.
1. We need an equitable system, covering all, according to their means.
2. I realize that Douthat is concerned about how universal health care might affect people working or employment opportunities, and he fears that some may choose to get health coverage for free but then simply choose not to work to pay for this nationally by his/her labor. One solution would be to consider allowing a person to work by volunteering for legitimate, apolitical nonprofits that provide community benefit other than merely to their own ethnic or religious group.
3. Given our national opioid problem and how many states are approving marijuana, beyond medical needs, I am concerned about how this system of physicians approving pharmaceuticals and many who wish to enjoy drugs beyond any specific medical need, may exacerbate our national problems.
4. I think that it is extremely important that another goal of universal health care must be continually analyzing Big Data from all hospitals and patients to improve the effectiveness of our medical systems. This is something that Kaiser Permanente and Hospitals has done superbly for many years, together with the Kaiser medical news group.
5. Emphasis on Preventive Care. This combined with a large emphasis on natural/seasonal foods and preparation will be very important.
6. New technologies and innovation should help many but especially the very young and elders.
Should have included Japan, where there is national health insurance for everyone, with reasonable premiums, that pays, I think, 70% of your bill and you can go, without an appointment to any doctor or hospital (in the latter case, seeing an expert in whatever department you need, provided you are willing to wait an hour or two at times). At least, that is how things worked when I lived there, but I have been back in the States for quite a while. No one seemed to complain about the health insurance, either.
1
One thing I noted that none of the commentators considered was the payment for doctors in the various systems or the what types of legal protections are afforded to care givers. I do know in Great Britain the legal system makes it much harder to sue due to their loser pays and that the government sets the salaries of the medical workers. To truly evaluate costs you have to consider the cost of doing business in each country which would include the who controls what is charged, and how much you have to pay for malpractice insurance. Are their caps on what you can recover if you do sue? I did notice in both the systems at the top, the government sets the price and what the workers are paid. you have to be able to compare apples with apples, not some hodgepodge of ideas.
Individual mandate is needed, subsidize on a scale, allow for private insurance, insurance pools across state lines, no employer involvement, a range of policies that would include a catastrophic plan to a Cadillac plan, maybe treat innovation the way we do with defense contractors, at least to some extent, cover pre-existing conditions but insurance can charge “some amount” more, you also need to pay more if you do certain things like smoke. Finally, maybe the Gov’t should be a back-stop for private insurance meaning that there could be some dollar maximum that a private insurer would be out of pocket for a patient after which the person would be switched to a state high-risk pool that is subsidized so that when you get switched you don’t have to pay more. Finally, we need some kind of tort-reform, total transparency of costs and to incentivize the behavior we want all across the system from the citizen, to the doctors, hospitals, insurance companies, drug and device companies and gov’t.
I’ve lived in Canada all my life. The Canadian system could certainly use improvements (like any country), but regarding wait times I think we get some bad press. Average wait time tells you nothing. The wait time is near zero with a life threatening issue. You are triaged immediately and if it is not serious, yes you may have to wait. With a “free” system (ie no patient cost) a gentle deterrent in the form of wait time might actually a good thing to deter “frequent flyers” (non-emergent matters.) It has probably evolved that way for a reason.
For my cataract surgery, I think I waited about 4 weeks and had absolutely no problem with that. Why would I need it right away? My optometrist detected the cataract before I did. Wait times are dependent on other factors like early detection.
My wife had knee surgeries (2nd one just recently.) I can’t remember how many times she put it off for her own reasons. Is her wait time incorporated into the data? She delayed for years with first knee. I think the wait time data might be too crude to just apply to all cases.
In these types of studies they usually conclude that outcomes in Canada are as good as any. It is just far too complicated to look at it any other way.
We had three children, all C-section. The only concern I ever had was choosing the names.
One thing the Canadian system needs is universal drug coverage. Having essentially the US system for drugs probably drags our ranking down a lot.
For my cataract surgery, I think I waited about 4 weeks and had absolutely no problem with that. Why would I need it right away? My optometrist detected the cataract before I did. Wait times are dependent on other factors like early detection.
My wife had knee surgeries (2nd one just recently.) I can’t remember how many times she put it off for her own reasons. Is her wait time incorporated into the data? She delayed for years with first knee. I think the wait time data might be too crude to just apply to all cases.
In these types of studies they usually conclude that outcomes in Canada are as good as any. It is just far too complicated to look at it any other way.
We had three children, all C-section. The only concern I ever had was choosing the names.
One thing the Canadian system needs is universal drug coverage. Having essentially the US system for drugs probably drags our ranking down a lot.
2
Doctors in Canada are, in general, paid much more than doctors in Britain. That contributes to longer Canadian wait times. There's only so many the system can afford to hire.
What a useless article. Canada being eliminated in the first round doesn't mean that the USA has better health care, but it got to the second round. You were comparing apples and oranges by doing these different showdowns. Just compare the level of healthcare overall. I think that you'd find that Canada is higher up than this article implies.
3
Why are all the judges men? Or, why aren't half the judges women? Or, why is there not even one woman?
3
Your list is quite short and omitted countries with outstanding health insurance systems. I lived and worked in 11 countries. Here are my personal ratings purely based on my experience with my wife and four kids and three grand kids (all delivered in different countries):
1. Israel
2. Netherlands
3. France
4. Switzerland
5. Singapore
6. Belgium
7. Finland
8. UK
9. Netherlands Antilles
10. USA
I base my ratings on what health insurance, medical treatments, medicine and doctors' visits cost me, quality of treatment, waiting times to see a doctor or have an operation or an exam, and, very important, empathy and time of the medical staff.
1. Israel
2. Netherlands
3. France
4. Switzerland
5. Singapore
6. Belgium
7. Finland
8. UK
9. Netherlands Antilles
10. USA
I base my ratings on what health insurance, medical treatments, medicine and doctors' visits cost me, quality of treatment, waiting times to see a doctor or have an operation or an exam, and, very important, empathy and time of the medical staff.
2
Enough about wait times in Canada. I've been on the wait list for knee replacement surgery for YEARS. Why? Because every time my number has come up, as it does every five months or so, I say no thanks, not yet, and go to the back of the queue. I shouldn't be counted as wait-listed but I am. And when I needed urgent spinal surgery some years back, I could have had it the very next day but no, I had to make arrangements for my 5-year-old and cats and lay in groceries. I was counted as "waiting" then too. Some people are counted as waiting if they are put on the list but required to lose weight or wean off alcohol or medications or resolve another medical issue before undergoing a procedure. Calculating wait times is a tricky business, and self-reporting by patients probably the least reliable method, yet I see article after article quoting the "one in five Canadians report" - nonsense that originated and has been tirelessly promoted by the right-wing Fraser Institute. Enough!
5
I wonder why Taiwan was not included. It seems to me the "paper of record" and most corporate media is resistant to honestly discussing healthcare. So much obfuscation. I guess this is predictable, but one wonders how we will ever fix this mess when our "news" is written and paid for by people paid and privileged by large corporations. https://www.umhs-sk.org/blog/health-care-around-world-taiwan/
Regardless of which system is chosen, everyone must keep in mind that government intrusion, reimbursement pressures, and the threat of lawsuits is driving physicians out of practice (the US government predicts a shortage of 90,000 physicians by 2020) and no matter how hard society wishes, if we don’t have enough doctors being rewarded to practice their craft, you won’t get treatment regardless of the payment model.
1
I had similar situations in Tasmania, Australia and a year later in San Jose, CA:
infection arising from poison ivy.
1. Treatment in emergency room for 3 hours including transfusion and medications in Australia: $50.
2. A 5 minute visit with doctor in emergency room and a prescription I had to pay for, in US: $750
Fortunately I had health insurance which paid a negotiated lower payment in US.
Strong proof we all need health insurance with well-negotiated rates.
infection arising from poison ivy.
1. Treatment in emergency room for 3 hours including transfusion and medications in Australia: $50.
2. A 5 minute visit with doctor in emergency room and a prescription I had to pay for, in US: $750
Fortunately I had health insurance which paid a negotiated lower payment in US.
Strong proof we all need health insurance with well-negotiated rates.
In comparing healthcare systems, it would be helpful if NYT also listed some key indicators of performance at the national level, such as life expectancy, and infant mortality rates. Also, it would be helpful to compare the health insurance politicians in government receives. I am happy with the universal healthcare system in Norway that provides the same benefits for everyone.
I live in the US and pay over $500 per month for health insurance. After deductibles and prescriptions and other things the insurance does not cover, my monthly bill is an average of about $700 per month, which takes a huge chunk of my pretty small retired income. I lived in the UK for the year 2014-2015. At one point, I had to go into the hospital for a night. The entire bill, including an ambulance to get me to the ER, inpatient care overnight in the hospital, several appts with cardiac specialists, a return visit to a specialist a few days later, and all drugs, was $1200. Fortunately I had purchased insurance for living outside the US, so I didn't have to pay for it. The care I received was absolutely wonderful, and I have had more than my share of experience with the medical world as a patient in the states. The biggest difference between the US and the UK is the attitude of the staff. In the UK everyone was attentive, helpful, very professional, but they weren't anywhere near as frantic as hospital staffs here have to be. In the UK, the staff was moving quickly to help patients but there was a calm in the ER, in the hospital, and in the clinics that does not exist here in the states. And no one asked me what my insurance covered; they just took good care of me. When I returned to the US and went to a cardiac specialist, the very first question he asked was, "What kind of insurance do you have? The treatment I think you should have may not be covered."
I'm 65, retired & lived in Canada all my life except for 3 years in Australia. I pay $260.00/month, of which approximately $100.00 goes to the Province for general revenue...the only Province in Canada I believe who taxes their citizens like this...that Government has now been voted out. That $260.00 covers eye glasses, dental work & maintenance, my prescriptions are covered also.
Regarding "wait times", to be fair, readers need to understand that, that is a regional issue, where by some areas of the country wait longer than others. We are a huge country, with few people, comprehensive medical services cannot be provided to all areas of the country. My wife & I just completed a 10 month coast to coast RV trip through the USA, then returned across Canada. You need to understand that Americas population density is 10 times ours, which will dictate services offered. I required a "hernia" operation a few years ago, I was told 8 months wait, the specialist assured me that wouldn't be the case. I was given the option to attend a "Private Facility", the cost would be $1200.00, & could be performed within the week. I chose to wait, surgery was performed by regular channels in 3 weeks. I had a Malignant Cancer in my right breast, attended a specialist, diagnosis was made, I was in surgery the next day & it was removed. I was placed under the care of our "Cancer Clinic" for a year afterwards until they felt I was clear. I go in for full exams every year.
Regarding "wait times", to be fair, readers need to understand that, that is a regional issue, where by some areas of the country wait longer than others. We are a huge country, with few people, comprehensive medical services cannot be provided to all areas of the country. My wife & I just completed a 10 month coast to coast RV trip through the USA, then returned across Canada. You need to understand that Americas population density is 10 times ours, which will dictate services offered. I required a "hernia" operation a few years ago, I was told 8 months wait, the specialist assured me that wouldn't be the case. I was given the option to attend a "Private Facility", the cost would be $1200.00, & could be performed within the week. I chose to wait, surgery was performed by regular channels in 3 weeks. I had a Malignant Cancer in my right breast, attended a specialist, diagnosis was made, I was in surgery the next day & it was removed. I was placed under the care of our "Cancer Clinic" for a year afterwards until they felt I was clear. I go in for full exams every year.
2
When my husband's stitches burst open in France, the local hospital provided the necessary care happily, at no cost.
When my grandson crashed his bike in the US, it took more than a year to sort out who paid for what.
When a friend fractured his hip in Japan last year, the repair was flawless, hospital amazingly quiet, and though his US insurance covered it, the cost would not have been devastating had he had to pay it. The surgeon invited him back for a tour of the town.
My friends in France and Germany and Sweden love their health care. No one I know in the US is happy, except those of us who reached Medicare without going broke.
When my grandson crashed his bike in the US, it took more than a year to sort out who paid for what.
When a friend fractured his hip in Japan last year, the repair was flawless, hospital amazingly quiet, and though his US insurance covered it, the cost would not have been devastating had he had to pay it. The surgeon invited him back for a tour of the town.
My friends in France and Germany and Sweden love their health care. No one I know in the US is happy, except those of us who reached Medicare without going broke.
2
I'm 66, retired, and live in Germany. My health insurance premium is approximately 125 euros a month, a portion of which is for home care if I should need it someday. I had heart valve surgery about three years ago, and I paid absolutely nothing. Well, not quite true. When I found out I needed the surgery, I worriedly asked the cardiologist how much I'd have to pay, and she very apologetically replied that I'd unfortunately have to pay my own train fare to the heart center in Leipzig. The return trip to Berlin to another hospital where I recuperated was in an ambulance, also absolutely free.
2
Panel members seem seriously out of touch with how very much Britain's National Health Service (NHS)has fallen into disrepair, and also how extraordinarily rigidities compromise outcomes. Data on socially oriented procedures such as live births and maternal outcomes remain world class, but repeated amateurish efforts at re-structuring and part-privatizing the giant system (begun by Labour PM Tony Blair) have left aspects in shambles and technologically decades behind most of the OECD. Social and financial support for the severely handicapped have been savaged in recent years; the British collective sub-conscious very much looks down and askance at the chronically ill -- a new snobbery sprung from entrenched class consciousness.
It would have been nice to see at least one woman as part of the panel of experts since an important part of the health care debate is maternity. Lastly, I've experienced both France (for five years including a pregnancy) and the US system. France wins by a landslide.
4
Colombia arguably has the best health care in Latin America. Workers pay 12% of their income (8% paid by employers) for health coverage and people who cannot afford to pay for a policy receive free coverage. Retirees pay 10% of their income for health insurance. The Colombian constitution defines health as a human right, so everyone--even foreign residents--can qualify for coverage.
Here is an article (second story on the page) I wrote a few years ago about the Colombia system: https://www.d76.us/writings
Here is an article (second story on the page) I wrote a few years ago about the Colombia system: https://www.d76.us/writings
Just a small inaccuracy in the article about the England's NHS access policy: it is free to all legal residents (irrespective of nationality), not citizens. UK citizens who reside abroad have to pay for all services. EEA visitors also receive free treatment provided that have a valid European Health Insurance Card (EHIC) issued by their home country.
Uwe: "Canada. The Canadian system is simpler for citizens to understand and highly equitable."
There is absolutely no system for Brits to understand. If we are sick we see our GP or if it's serious we call an ambulance. What's to understand?
Of course I am thankful for our NHS. As a severe COPD patient from the lowest socioeconomic group I have better health care than fellow patients I know from around the world - I say this as someone who travels and meets with COPD patients internationally. I am visited in my home 6 monthly by respiratory specialist oxygen nurses, have 6 monthly checkups with my GP - and this is proactive care in addition to any other care I may need for ill health. Today I have my free annual 'flu jab. Last week I was at the dentist for a clean &some cosmetic work where I had a gap between a crown and receeding gum line - free. I have an oxygen concentrator for my needs in the home, a tank of liquid oxygen from which I fill portable flasks for when I am out and about, and a backup cylinder in the house for if there's a power failure. All free. And if I go on vacation I call the suppliers with my destination address and an identical set up is ready and waiting for me on arrival. I am also provided with a portable concentrator for travel within the UK. My USA counterparts struggle to get their oxygen needs catered for - and few are lucky enough to get liquid oxygen due to it's expense. And If ever I need a transplant, that too is free.
There is absolutely no system for Brits to understand. If we are sick we see our GP or if it's serious we call an ambulance. What's to understand?
Of course I am thankful for our NHS. As a severe COPD patient from the lowest socioeconomic group I have better health care than fellow patients I know from around the world - I say this as someone who travels and meets with COPD patients internationally. I am visited in my home 6 monthly by respiratory specialist oxygen nurses, have 6 monthly checkups with my GP - and this is proactive care in addition to any other care I may need for ill health. Today I have my free annual 'flu jab. Last week I was at the dentist for a clean &some cosmetic work where I had a gap between a crown and receeding gum line - free. I have an oxygen concentrator for my needs in the home, a tank of liquid oxygen from which I fill portable flasks for when I am out and about, and a backup cylinder in the house for if there's a power failure. All free. And if I go on vacation I call the suppliers with my destination address and an identical set up is ready and waiting for me on arrival. I am also provided with a portable concentrator for travel within the UK. My USA counterparts struggle to get their oxygen needs catered for - and few are lucky enough to get liquid oxygen due to it's expense. And If ever I need a transplant, that too is free.
Dentistry in the UK is NOT free for most people, at least if you have a job. As an NHS patient, you have to contribute to the cost each time you have any dental work done. If you're private it costs even more. Also, depending on where you live in the UK - it can no longer be called a 'National' Health Service given the differences - prescriptions may not be free.
There is also a huge difference between health care and so-called social care. For the latter you often have to pay all of it yourself, or certainly make a significant contribution to the cost. Which is totally unfair. Why should someone who develops a physical brain disease such as Alzheimer's suddenly have to pay for their own care, which they need otherwise they would literally starve to death? I think we should commercialise the BBC and put the £3 billion the public pays for that every year to fund elderly social care. Strange that we are prepared to pay directly for 'entertainment' but not for essential care.
There is also a huge difference between health care and so-called social care. For the latter you often have to pay all of it yourself, or certainly make a significant contribution to the cost. Which is totally unfair. Why should someone who develops a physical brain disease such as Alzheimer's suddenly have to pay for their own care, which they need otherwise they would literally starve to death? I think we should commercialise the BBC and put the £3 billion the public pays for that every year to fund elderly social care. Strange that we are prepared to pay directly for 'entertainment' but not for essential care.
You really should look into the Dutch healthcare system. I'm a Swede but lived for three years in The Netherlands. Unfortunately my job was terminated but their well-functioning health care system that belongs to the top 5 in the world is one of the reason I'm seriously contemplating moving back.
It would be to lengthy to outline all the details here but the fact that it i an almost perfect combination of mandatory, insurance-based and privatized makes it, in my opinion, absolutely top notch.
It would be to lengthy to outline all the details here but the fact that it i an almost perfect combination of mandatory, insurance-based and privatized makes it, in my opinion, absolutely top notch.
UK is not single-payer. Single payer by definition means no parallel or duplicate coverage. In practice that means formal rules BARRING private insurers from covering services covered by the "single payer," ie the government insurance plan. In Canada we deem that only "medically necessary" physician and hospital services are (publicly) "insured;" private insurers can cover other publicly funded services like home care but not the core, ie physicians and hospitals. This must sound weird to the average American. It IS weird - almost unique in the world. We developed it precisely because we're in a unique position, next door to the US and with so much in common. Our single payer system exists to PROTECT our system from turning into the US one. It works for us but most other countries don't need it, and it's the hardest possible way to get universal coverage in the US itself. The "best" system for any country grows out of ITS OWN values, culture, and heritage; this game of choosing some other system for x y or z is absurd. The other essential point is that health CARE is a small factor in HEALTH. Health mostly reflects overall social solidarity, especially equity in income distribution, and other cultural factors. And just by the way, Canada whips the UK on by far the most important measure of the outcomes of care, "amenable mortality" - but the authors never mention it, even though the Commonwealth Fund itself highlights it. Frankly, guys, try again.
Steve Buick
Steve Buick
3
with women's health care a continuing "wedge" issue in the american healthcare debate, you didn't think it pertinent to include a female panelist? it's telling that we are continually left out of a conversation that includes us, even in no-stakes things like a NY Times analysis.
4
The healthcare system here is socialized with some private options. You won't find plush waiting rooms or fancy buildings within the public system. You won't find a lot of that even in the private clinics, as well. But the doctors and nurses are quite good, their expertise level is solid, and the care is good, and very affordable. Everyone is covered, and so there's no sense of desperate dread like in the USA revolving around coverage. Sadly, I think too many of Poland's doctors and business "entrepreneurs" are looking Westward - as has been their habit, for better or worse, for some time now - and seeing more money to be made in private, for-profit operations. There's resistance, but too often it's blended w/ awful, otherwise right-wing politics (Catholics controlling hospital/health policy, racism, nationalism, sexism, etc.). But - FOR NOW - the system is pretty good as is, sometimes very good. Less desperation among average citizens and much less inequality overall.
1
Turn your "competition" around and which system is worst? The US would be the clear winner. You paired the US vs Singapore for what reason? There are many better candidates for exemplary systems of health care....it seems you did so for the US to have a win.
3
Or maybe the root os the problems faced in this area by Americans is:
Americans have the lowest respect for human life among the competing countries.
Yet another indicator of a country in decline.
Many countries are better places to raise children and offer potential for an improved quality of life at less rick than the U.S.
Americans have the lowest respect for human life among the competing countries.
Yet another indicator of a country in decline.
Many countries are better places to raise children and offer potential for an improved quality of life at less rick than the U.S.
3
What has not been mentioned is the tremendous administrative waste in our system. I strongly support and recommend one set of guidelines based on standard of care for care coverage throughout the payment system, not multiple guidelines even within multiple plans of one insurance company. These appear to be base on maximizing profit much more than they are based on the standard of care. The latest study I am aware of suggest each physician in America spends $84,000 a year just to interact with the health insurance industry.
1
I am 72 and have had medical help in three other countries: Italy, India and Mexico. Remarkably the treatment in Mexico was very cheap, and very very good. I had a bad accident in Mexico and went to the local doc who stitched me up, gave me a round of tetanus shots, bandaged my ribs and arm, and visited me in my motel three times, for )hold your breath) $240 (about 9 years ago.
In Italy I had back pain so I went to the local doc in Florence) and he gave me a thorough exam, and pain meds, for about $15.
In India I had a long (month long) round of Aruvedic treatment. A daily full body message, steam bath, oil rub down plus lots of Aruveduc meds- for about $800.
Any one of these treatments beat anything I have ever had in America, at a fraction of the cost.
If only we could say: maybe other countries have something to teach us, especially on how to get the profit motive out of health care, especially in insurance and pharmaceuticals. Hope I live that long.
In Italy I had back pain so I went to the local doc in Florence) and he gave me a thorough exam, and pain meds, for about $15.
In India I had a long (month long) round of Aruvedic treatment. A daily full body message, steam bath, oil rub down plus lots of Aruveduc meds- for about $800.
Any one of these treatments beat anything I have ever had in America, at a fraction of the cost.
If only we could say: maybe other countries have something to teach us, especially on how to get the profit motive out of health care, especially in insurance and pharmaceuticals. Hope I live that long.
6
The problem with local doctors in the UK, called GPs, is that they basically just prescribe pills. For the treatment you received after your accident, here you would have to go to the local hospital. And then people wonder why it can take 12 hours to be seen there!
None of your analysis considers the wealth of doctors. Please add this to the conversation. In which of these countries do doctors make the most money. American doctors won't accept lower pay for their work.
2
Sure they will. One can still live on 250K.
"One can still live on $250k.." ...especially if they don't have to pay for an office staff to handle the blizzard of paperwork and duplication in filing, bargaining and asking permission from so many health insurance companies.
1
I'm a liver transplant surgeon. My wife and I have worked in India and the US. I have physician friends in Canada, Brazil, Mexico, Singapore, UK, Korea, Japan, Taiwan, Turkey, Egypt and this is an area of interest for me so I have discussed the way health care is delivered in all these countries.
I think the best healthcare system might be what the Indian healthcare system was originally conceived as. You have a public healthcare system which provides all essential services free of cost and a private healthcare system where you can pay for things like more comfortable rooms, shorter waiting times, selecting your physician and so on.
Unfortunately, the Indian government never made healthcare enough of a priority. Funding remained minuscule and most Indians have no access to healthcare at all.
I think the best healthcare system might be what the Indian healthcare system was originally conceived as. You have a public healthcare system which provides all essential services free of cost and a private healthcare system where you can pay for things like more comfortable rooms, shorter waiting times, selecting your physician and so on.
Unfortunately, the Indian government never made healthcare enough of a priority. Funding remained minuscule and most Indians have no access to healthcare at all.
1
My son has lived in Ontario, Canada for 15 years. He and his wife have graduate degrees in mathematics and computer science. Both are teachers; one at the college level; one, in high school. Canada pays its teachers well. They happily fork over 40% of their income in taxes. They know exactly what they get for it--free, quality health care for themselves and their three children, splendid public education and roads. They might grumble about this and that but they do not want what the United States has. I truly believe the case can be made to Americans that they will pay far less for better health care with any of the health systems described in the article if they compare what they pay now for insurance, Medicare, taxes, copays and deductibles.
5
For your son, taxes consume more of his average family’s income than all the basic necessities of life combined. If you add up the average family’s spending on housing, food and clothing in a year, it comes to 37.4 per cent of its income in Canada.
That’s 42.5 per cent of income going to taxes.
Many entrepreneurial Canadians vote with their feet.
That’s 42.5 per cent of income going to taxes.
Many entrepreneurial Canadians vote with their feet.
Indeed. Denmark also has high taxes, but then it has a good health and social care system. I dont think its a coincidence that the Danes have been seen as some of the most content people around. Unfortunately in the UK, successive governments simply refuse to raise taxes - they actually lower them - because its viewed as a vote loser.
Taiwan. Period.
As a Singaporean citizen diagnosed with stage 4 brain cancer in my 20s without any private insurance of my own, I would have to say I enjoy the benefits of the healthcare system I have here.
When I underwent surgery to remove the cancerous tumour, the cost of surgery and hospitalisation and medication for the next few weeks amounted to zero. Sure, there were deductions from my medisave( the mandatory savings account) but for many of us growing up in Singapore, we understand they we should not depend on the government to provide everything for us.
The government hospital also arranged for a counselor to see those diagnosed with cancer to care for their mental health and organises group meetings for those with similar conditions. It is easier to speak with someone who has been through cancer as well.
The post surgery treatment was heavily subsidised as well where for the post op 6 weeks of intense chemo and 6 months of chemo at home cost me 0 as well, while radiotherapy cost me about $3200.
For those who cannot afford treatment, usually the hospital works out a payment plan that does not put a strain on the family's finances by working with a medial social worker(also provided by the government hospital)
With regard to quality of care, the team of specialists that I saw and still see all tended to have private practices outside, so they are paid to see patients within the hospital premises at a far cheaper rate. The same doctor costs me 38 while outside would be 150
When I underwent surgery to remove the cancerous tumour, the cost of surgery and hospitalisation and medication for the next few weeks amounted to zero. Sure, there were deductions from my medisave( the mandatory savings account) but for many of us growing up in Singapore, we understand they we should not depend on the government to provide everything for us.
The government hospital also arranged for a counselor to see those diagnosed with cancer to care for their mental health and organises group meetings for those with similar conditions. It is easier to speak with someone who has been through cancer as well.
The post surgery treatment was heavily subsidised as well where for the post op 6 weeks of intense chemo and 6 months of chemo at home cost me 0 as well, while radiotherapy cost me about $3200.
For those who cannot afford treatment, usually the hospital works out a payment plan that does not put a strain on the family's finances by working with a medial social worker(also provided by the government hospital)
With regard to quality of care, the team of specialists that I saw and still see all tended to have private practices outside, so they are paid to see patients within the hospital premises at a far cheaper rate. The same doctor costs me 38 while outside would be 150
1
France- for many reasons, but primarily because their system is well organized and administered which results in better and more efficient care for patients. Check out their "card of life," which contains timely, accessible and secure health care/financial info and speeds payment to doctors and hospitals. Far less paper and insurance hassles and denials.
Note: in the summary on the US it states hospitals are private with the exception of the VA, not true as there are a number of public hospitals, many of which are county entities like Cook County IL. PA is one state that has no public hospitals, but it is the exception.
Nevertheless, there is much we could learn from other countries, good article.
Note: in the summary on the US it states hospitals are private with the exception of the VA, not true as there are a number of public hospitals, many of which are county entities like Cook County IL. PA is one state that has no public hospitals, but it is the exception.
Nevertheless, there is much we could learn from other countries, good article.
1
Lived in Switzerland for a decade, still here, had 2 babies and some other significant health issues. High quality, transparent and affordable coverage, no stress when the bill arrives. Particularly with the pregnancies/deliveries/post-natal care, the US seems inhumane in comparison. Also had a severe leg fracture while skiing in France 9 years ago. Six days in the hospital, a 5-hour surgery, all the radiology, nursing, PT, food, etc., for the grand total of 90 Euros which was about 150 USD at the time. We paid the bill in full before leaving the hospital.
4
User voting is clearly more informed than your 'experts'. It is clear that models like the French and British are clearly better than the more private models that this article extols. Having the US actually beat anyone is laughable.
7
What Americans fail to understand is that we pay far more for our health care (17% of GDP) than France or England which are about 10% of GDP. And their public health outcomes are better. And everyone, from poor working class to wealthy is more relaxed because they know they are covered. The complaint here is that taxes will go up. Of course, but the total cost goes down. I'm well-off, financially and can afford care, but I would much rather live in a healthier society where everyone is taken care of. Why are Americans so unable to do the most basic cost-benefit analysis: single-payer = significantly lower price and better results.
4
Interesting Fact
Population numbers
Australia. 26.13 million
Canada. 36.24 million
France. 66.90 million
Germany. 82.67 million
Singapore. 5.607 million
Switzerland. 8.372 million
United Kingdom. 65.64 million
. Total. 289.672 million
United States. 323.1 million
The United States have 33.428 million more people than the combined total of the other 7 countries included in this article. Seeing how different each of the survived countries health care systems are from each other, it's easy to see how difficult it is for the United States to put together a health care system everyone would accept.
Population numbers
Australia. 26.13 million
Canada. 36.24 million
France. 66.90 million
Germany. 82.67 million
Singapore. 5.607 million
Switzerland. 8.372 million
United Kingdom. 65.64 million
. Total. 289.672 million
United States. 323.1 million
The United States have 33.428 million more people than the combined total of the other 7 countries included in this article. Seeing how different each of the survived countries health care systems are from each other, it's easy to see how difficult it is for the United States to put together a health care system everyone would accept.
3
Three encounters with Italy’s system in a year. Upon arrival we went to the hospital with a letter, in Italian, stating the need to remove my facial stitches today. Hours in line to see the single triage nurse then sent to a doctor. Without looking at me he said we needed to return 3 days later, then walked out. Our landlady took me to her doctor who removed the stitches & refused any payment.
A week later (Good Friday, start of the country's most celebrated holiday) my husband had chest pains. Calls to every cardiologist rang unanswered. When we found the number for emergency, he was taken to the hospital at 11 PM. They did several EKGs, called a cardiologist, & admitted him to a ward. The ward experience was unpleasant, but doctors were attentive ordering tests & EKGs. No heart damage. After 2 days he was released, but hospital personnel called several times to check on his status. We were never charged a penny.
Outside Rome my husband got a detached retina. Our medical insurer arranged an immediate eye appointment. Next day he entered a specialty hospital, going to the front of the line for every test (while others waited for a monthly preventative EKG) Bypassing others in the waiting room, the top eye surgeon operated early next morning,. Me in adjoining bed in his private room for 3 days. $10K—paid by our expat insurance. Bottom line: Everyone is covered—but might have to wait. Private insurance goes to front of the line. Prevention rather than critical focus, superb!
A week later (Good Friday, start of the country's most celebrated holiday) my husband had chest pains. Calls to every cardiologist rang unanswered. When we found the number for emergency, he was taken to the hospital at 11 PM. They did several EKGs, called a cardiologist, & admitted him to a ward. The ward experience was unpleasant, but doctors were attentive ordering tests & EKGs. No heart damage. After 2 days he was released, but hospital personnel called several times to check on his status. We were never charged a penny.
Outside Rome my husband got a detached retina. Our medical insurer arranged an immediate eye appointment. Next day he entered a specialty hospital, going to the front of the line for every test (while others waited for a monthly preventative EKG) Bypassing others in the waiting room, the top eye surgeon operated early next morning,. Me in adjoining bed in his private room for 3 days. $10K—paid by our expat insurance. Bottom line: Everyone is covered—but might have to wait. Private insurance goes to front of the line. Prevention rather than critical focus, superb!
Idealistically, I prefer the British model. But I wonder if each of these countries faces problems as difficult as those in the US.
I'm thinking that the US has a much larger portion of unhealthy people, statistically, than in these other countries. So I'm thinking that access to healthcare in the US would be worse under universal coverage than in other countries, with perhaps more healthcare providers per unhealthy citizen.
So, for the countries mentioned, is the population healthier (statistical mean or median) than in the US?
Is the health of the population as diverse (statistical variance) than in the US?
Do these countries have as large a problem with diabetes as in the US?
Do these countries have as large a problem with opiates as in the US?
Do these countries have as large a rural population as the US, where access to healthcare is more difficult?
I'm thinking that the US has a much larger portion of unhealthy people, statistically, than in these other countries. So I'm thinking that access to healthcare in the US would be worse under universal coverage than in other countries, with perhaps more healthcare providers per unhealthy citizen.
So, for the countries mentioned, is the population healthier (statistical mean or median) than in the US?
Is the health of the population as diverse (statistical variance) than in the US?
Do these countries have as large a problem with diabetes as in the US?
Do these countries have as large a problem with opiates as in the US?
Do these countries have as large a rural population as the US, where access to healthcare is more difficult?
I genuinely think the opiate/opiod crisis in the USA is largely born out of the insane levels of inequality and desperation and fear there now. People are scared about their employment situation, scared about their health insurance coverage, and scared about how their crazy president is going to destabilize their lives even further. People are self-medicating with these drugs. And then they're hooked, and then they have no real treatment options (just jail!!), and then it becomes a hellish downward spiral. It's well and truly sad. (I'm a US citizen, btw, but have been living abroad for over a decade. Lots of my friends and fam remain in the States)
2
On the first night of our re-entry to Canada, after many years in the US, my wife, 4-year-old daughter and I went to an automatic laundry. The front was all glass, including the massive stainless steel framed pneumatic doors. When someone came in, the doors closed with my daughter's hand between the door back and wall frames. It came out perfectly flat, paper thin. It was midnight.
The doctor who was called in to meet us at the hospital in Saskatoon, Saskatchewan, was matter-of-fact, saying not to worry, chldren of that age are "made of rubber," treated her, and soon her hand was normal and she stopped crying.
Cost of emergency treatment? Zero. Cost of injections and a milk tranquilizer? Zero. Were we asked for identification? No. I gave my daughter's name and mine, and we were on our way.
Blackcomb Mountain ski resort, British Columbia, years later. Skiing alone, end of day, at high speed, near a ski lift with more than 30 people waiting, and then watching, me, I crashed face first into an ice wall thrown up by a snowplow, biting off the tip of my tongue, peeling away half my face and breaking ribs that punctured a lung.
Helicopter lifted to Hospital, I was isolated behind curtains -- "to not scare the children." The next day, after plastic and other surgery, I asked (writing, the remainder of my tongue too swollen to talk), if someone would ask for pay or my insurer's name: It's illegal for us to mention payment in the first 72 hours after receiving an emergency."
The doctor who was called in to meet us at the hospital in Saskatoon, Saskatchewan, was matter-of-fact, saying not to worry, chldren of that age are "made of rubber," treated her, and soon her hand was normal and she stopped crying.
Cost of emergency treatment? Zero. Cost of injections and a milk tranquilizer? Zero. Were we asked for identification? No. I gave my daughter's name and mine, and we were on our way.
Blackcomb Mountain ski resort, British Columbia, years later. Skiing alone, end of day, at high speed, near a ski lift with more than 30 people waiting, and then watching, me, I crashed face first into an ice wall thrown up by a snowplow, biting off the tip of my tongue, peeling away half my face and breaking ribs that punctured a lung.
Helicopter lifted to Hospital, I was isolated behind curtains -- "to not scare the children." The next day, after plastic and other surgery, I asked (writing, the remainder of my tongue too swollen to talk), if someone would ask for pay or my insurer's name: It's illegal for us to mention payment in the first 72 hours after receiving an emergency."
6
Wow. It sounds as if kindness and humanity were DESIGNED right into the healthcare system. Imagine that!!
3
Where are the WOMEN'S voices in this "evaluation"? Considering that WOMEN'S health care appears dispensable (maternity care deleted in new Rep. legislation!!), over HALF the population's views and needs are excluded here.
There was a much more comprehensive comparison study done by a TV network some years ago which included JAPAN. Switzerland sounded the best back then; insurance was required, it was provided by private companies who were not allowed to profit. The biggest problem in the USA is the competition for the medical treatment dollar between PROVIDERS and SHAREHOLDERS; guess who loses?
There was a much more comprehensive comparison study done by a TV network some years ago which included JAPAN. Switzerland sounded the best back then; insurance was required, it was provided by private companies who were not allowed to profit. The biggest problem in the USA is the competition for the medical treatment dollar between PROVIDERS and SHAREHOLDERS; guess who loses?
3
In 2008 I suffered a bad burn on my leg at home in Vienna, Austria and was treated in a hospital there.
I then had to fly to Washington DC and to have my bandage changed at George Washington hospital. Although I offered my credit card details to both the hospital and the physician, and pointed out my address was in Vienna, Austria, not Virginia, neither was interested.
I then flew on to Sydney, Australia, where my burn had to be treated again. The treatment in all 3 hospitals was more or less the same, although in Vienna and Sydney it was delivered by specialist nurses, rather than by a very overtired doctor as in Washington.
The treatment was free in Vienna and did not cost much in Sydney. Months later, I received a series of conflicting invoices from the American hospital. When I rang from Vienna, I was told not to pay as they were wrong and I would be sent another, with credit for not being insured and that it was expected I should negotiate the fees charged!
From the physician in Washington I never received an invoice but only a number of statements that the fees were overdue. I could see why from the envelopes - each bore my address in Vienna, but with no country. On one, someone had written "Italy", on another "France" while the third had "try Austria".
My impression from USA was that the hospital administration was cumbersome and the staff poorly trained and educated.
An interesting comparison of health systems in 3 countries.
I then had to fly to Washington DC and to have my bandage changed at George Washington hospital. Although I offered my credit card details to both the hospital and the physician, and pointed out my address was in Vienna, Austria, not Virginia, neither was interested.
I then flew on to Sydney, Australia, where my burn had to be treated again. The treatment in all 3 hospitals was more or less the same, although in Vienna and Sydney it was delivered by specialist nurses, rather than by a very overtired doctor as in Washington.
The treatment was free in Vienna and did not cost much in Sydney. Months later, I received a series of conflicting invoices from the American hospital. When I rang from Vienna, I was told not to pay as they were wrong and I would be sent another, with credit for not being insured and that it was expected I should negotiate the fees charged!
From the physician in Washington I never received an invoice but only a number of statements that the fees were overdue. I could see why from the envelopes - each bore my address in Vienna, but with no country. On one, someone had written "Italy", on another "France" while the third had "try Austria".
My impression from USA was that the hospital administration was cumbersome and the staff poorly trained and educated.
An interesting comparison of health systems in 3 countries.
3
Article 25 of the UN's Universal Declaration of Human Rights 1948 states that "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services." Nowhere does it mention your ability to pay for it. I'm Brazilian, and we have no illusions as to how precarious the national healthcare system is, but never have we debated whether or not it should exist - the question is, and has always been, how to improve it. The first time I heard someone (an American) say they didn't want to pay taxes to cover other people's healthcare, I was in shock. "It will cover you too" I said, "and how can you sleep at night knowing that there will be people dying in the streets with no access to a doctor for things that could be treated or cured? All that unnecessary human suffering because you wanted the illusion of paying only for yourself?" It's a clear example of how American individualism has overtaken common sense and decency. Having lived in England for years, I can attest to how much weight is taken off your shoulders when you can trust that any health issue you encounter will be promptly and well treated without having to worry about money. When I was below age 19, the NHS paid even for my prescription glasses. Moving to France and Germany I had an added inconvenience: things aren't free, they're reimbursed, so you need to pay upfront, but care is equally great.
3
The question that bears consideration is: Is basic healthcare a right or a luxury item?
Quick anecdote- While traveling in Ireland I slipped on a jetty resulting in a large bruise on my hip, prohibiting movement. I sat patiently while on a Sunday afternoon at about 5pm my spouse went in search of a pharmacy for pain and swelling relief. In my absence, after asking several questions of my spouse, the pharmacist provided a strong pain killer, anti imflammatory and ice- all for free to a non resident. I shutter to think how this situation would have played out in the US. Imagine the pharmacist directing me to a hospital, the long wait time, the emergency room bill, the bill for medicines.
My wife had a similar experience in Spain with a pharmacist providing a "prescription" anitidote for pink eye. In Mexico, we were given great dental care, with 20+ year experienced dentists, for $20 for a complicated filling procedure, all done with 24 hours notice. Again, all this for "foreigners".
Clearly in these diverse countries, basic medical care is a right and the patient benefits. Sounds like the countries with the best insurance plans share this view.
Quick anecdote- While traveling in Ireland I slipped on a jetty resulting in a large bruise on my hip, prohibiting movement. I sat patiently while on a Sunday afternoon at about 5pm my spouse went in search of a pharmacy for pain and swelling relief. In my absence, after asking several questions of my spouse, the pharmacist provided a strong pain killer, anti imflammatory and ice- all for free to a non resident. I shutter to think how this situation would have played out in the US. Imagine the pharmacist directing me to a hospital, the long wait time, the emergency room bill, the bill for medicines.
My wife had a similar experience in Spain with a pharmacist providing a "prescription" anitidote for pink eye. In Mexico, we were given great dental care, with 20+ year experienced dentists, for $20 for a complicated filling procedure, all done with 24 hours notice. Again, all this for "foreigners".
Clearly in these diverse countries, basic medical care is a right and the patient benefits. Sounds like the countries with the best insurance plans share this view.
2
Weird how you picked the UK and Germany but not The Netherlands. According to the annual Euro Health Consumer Index (EHCI) The Netherlands systematically has the best healthcare in Europe -yes better than Switzerland, year on year, and with the UK at 14th sandwiched between Portugal (13th) and Czech Republic (15th). I know the NY Times can't help to be English speaking and thus biased to the Anglo-Saxon world view but really the UK nor NHS belong in this article. They're just another mediocre European country when it comes to healthcare.
The Dutch would never admit their system was worse than anyone else's, whereas the British love to moan about anything and everything, and without the ability to actively participate in and therefore compare other country's healthcare systems, a consumer index is moot by definition.
the Dutch are not the ones defining thee classification standards. The Dutch moan a lot about their healthcare system despite having about the best one on the planet. Mind you they pay a whole lot ,ore than the British people do. I have lived in a variety of countries including the US, Netherlands and UK and I can attest the UK has the cheapest but also worst healthcare system I have ever seen.
Both my wife & I have been sick a few times in France. Their service was IMPECCABLE!!!! we are SD citizens and were tourists in France. We just went to a local doctor, there was a sign on the door that said: consultation is Euro 23. After he gave us prescriptions his printer automaitically gave us two filled insurance forms: one for the consultation & one for the medicines. At the pharmacy we gave the form and they gave us the medicine, for antibiotics for urinary and bronchial infections the cost to us was less than Euro 6 each time. In the US it would have cost at least ten times that amount.! there were never any questions of "did we have insurance or nationality". Getting ill in France is a BLESSING.
My pick was France, but that's based on experience with family members. Not a huge fan of Germany's system. Long waiting times, poor prevention and very poor outcomes.
In these articles and subsequent comments I always wonder where the issue of profit is addressed. Is our high GDP spending percentage mostly a reflection of our profit motive value system?
Do we look the other way anytime someone begins to suggest that medicine is not necessarily the place to make a lot of money? Our capitalistic extremism (compared to the rest of the world) renders us unable to imagine any motivated and efficient entity without an unlimited profit potential.
Until we can really extract profit from the GDP medical spending percentage I refuse to use that as an accurate measure of efficiency.
And until we agree "socialism" isn't a dirty word and realize almost all government services are a form of same, we will continue to attract our least effective and efficient workforce to it's cause.
Do we look the other way anytime someone begins to suggest that medicine is not necessarily the place to make a lot of money? Our capitalistic extremism (compared to the rest of the world) renders us unable to imagine any motivated and efficient entity without an unlimited profit potential.
Until we can really extract profit from the GDP medical spending percentage I refuse to use that as an accurate measure of efficiency.
And until we agree "socialism" isn't a dirty word and realize almost all government services are a form of same, we will continue to attract our least effective and efficient workforce to it's cause.
2
Very engaging feature by a well-qualified panel of experts in health economics and policy. Props to @nytimes for running this article. I urge you to offer other features like this to encourage more thoughtful scrutiny and deliberation about ways to improve the US healthcare system by drawing upon what has worked well elsewhere.
I'm sure that any attempt to rank order the key desired attributes of a high-functioning health system would not result in unanimity (preferences for good patient experience, access, cost, quality are anything but static). That's why this compare/contrast exploration can help us move beyond sloganeering and partisan politics, to focus on the root causes and challenges at hand.
Better coverage for more people at lower cost will only come if we are willing to tackle entrenched interests, invest in prevention/wellness, root out wasteful &/or fraudulent administrative practices, and address clinical workforce issues (burnout, improving access, bolstering primary care workforce). Well-intentioned endeavors like Medicare for All still don't address some of this critically important issues. Thanks @UpshotNYT!
I'm sure that any attempt to rank order the key desired attributes of a high-functioning health system would not result in unanimity (preferences for good patient experience, access, cost, quality are anything but static). That's why this compare/contrast exploration can help us move beyond sloganeering and partisan politics, to focus on the root causes and challenges at hand.
Better coverage for more people at lower cost will only come if we are willing to tackle entrenched interests, invest in prevention/wellness, root out wasteful &/or fraudulent administrative practices, and address clinical workforce issues (burnout, improving access, bolstering primary care workforce). Well-intentioned endeavors like Medicare for All still don't address some of this critically important issues. Thanks @UpshotNYT!
An interesting factor would be the effect geography has on the healthcare system design. It would seem reasonable that smaller, more dense countries are going to be better in terms of access per %GDP spent. The US, Canada, and Australia all seem to lag behind in access when compared to the others which have much denser populations. As with any infrastructure problem, reaching every last customer in a country has increasing costs as their are fewer customers over which to spread the fixed costs. Supposed the costs of building facilities isn't passed through in the care cost, the cost of travel for some more remote places can be instead. One could spend 1-2 hours driving each way to the hospital for a specialist visit, scan, or procedure and need to loose a whole day of work. Overall, although the more socialized systems seem nice, there will be additional challenges faced due to the simple logistics of getting patients to and from care centers.
I suspect that the head-to-head bracket system and the overvaluing innovation was used so as not to reveal, in the newspaper of record no less, that the US system is the laughingstock of the developed world.
Innovation is important, but there are much better ways of funding it than the US model of public-financed R&D which is then turned over to the private sector who are allowed to set their own price, sans bargaining.
As far as a mixed system is concerned, our health insurers dread that because they know they cannot compete with even a mediocre government run option, as we saw with the insurers' grand mal seizures when Obama briefly toyed with the idea of a public plan.
Innovation is important, but there are much better ways of funding it than the US model of public-financed R&D which is then turned over to the private sector who are allowed to set their own price, sans bargaining.
As far as a mixed system is concerned, our health insurers dread that because they know they cannot compete with even a mediocre government run option, as we saw with the insurers' grand mal seizures when Obama briefly toyed with the idea of a public plan.
7
Happy to see this since I have filed countless health-care commments that end by noting that the Times has been delinquent in presenting descriptions of Universal Health Care programs in countries more humane to their citizens than my USA.
I do not have the time to play the comparison game but a scroll down of the comments tells me once again that perhaps the best place to learn about UHC is read about first-hand experience in UHC countries. I have filed such so will not do so today. I will try to test the presentation tonight to see if it provides what I wanted the Times to provide.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
I do not have the time to play the comparison game but a scroll down of the comments tells me once again that perhaps the best place to learn about UHC is read about first-hand experience in UHC countries. I have filed such so will not do so today. I will try to test the presentation tonight to see if it provides what I wanted the Times to provide.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
@ myself - I did the choice game and have two comments.
1) You should have a definition of Single Payer and other systems. Readers sometimes argue about this. I use Universal Health Care as the name for the Swedish system that provides me with health care. In this system everyone has the same access, but there are private-public options available that work very well when you might want quicker booking or a second opinion.
2) Singapore-USA comparison was impossible since there is not enough information. A poor choice
1) You should have a definition of Single Payer and other systems. Readers sometimes argue about this. I use Universal Health Care as the name for the Swedish system that provides me with health care. In this system everyone has the same access, but there are private-public options available that work very well when you might want quicker booking or a second opinion.
2) Singapore-USA comparison was impossible since there is not enough information. A poor choice
1
This article makes it sound as if the U.S. healthcare system were fine and it just needed a couple tweaks. It is anything but fine! Many countries have it a lot better without the greed of insurance CEOs making prices higher. Healthcare is a public good, which is why the countries with public health systems are doing much better. We have to stop the stupid idea that government management is inefficient and that all things private are efficient. This is false, a myth that has hurt the U.S. for decades, the healthcare system is crippling this country, let's change it!
4
I think about the VA system when I think of government inefficiency and the US Postal Service. You can't fire anyone and the workers there for the most part could care less whether they do their job or not.
I think about Medicare and Social Security - two programs that work better than any comparable program in the private sector.
1
That is NOT TRUE! The VA system has the best system of specialists and doctors communicating with each other. Whenever my husband goes for an appointment for any reason he is required to input his VA card. Each person he sees can pull up his medical history, test results, etc. from the entire system, whereas, whenever I consult a medical provider, I have to keep verifying results have been sent to my PCP, or specialist provider. Competing practitioners rarely talk to each other!
The US health care system is becoming more fragmented than ever before with new levels of personnel being created to do more specific tasks. Each of these levels have a piece of the patients' information that is often not shared in an integrated manner. This leaves room for error and mismanagement of the patients' condition. There are just too many levels involved in patient care and this can be very confusing. Because of this, even more levels have to be created to help the patient access care e.g patient navigators, care coordinators etc. If patients are not savvy enough about their own health, and the health care system, they easily get lost in a maze of twists and turns, losing continuity in their care. From the providers' perspective, reliance on electronic medical records that are often cumbersome to navigate and use means that access to good information relevant to specific patients, may be unavailable when it's most needed. Improved sharing of information and more integrated care is what is needed in order to make pertinent decisions about patient care that will positively impact patient outcomes!
1
I have practiced medicine for nearly 40 years, mostly in a large academic health center. The frictional administrative costs of multiple insurers, each with its own forms, rules, payment, denials and appeals apparatus, highly paid C-suites, shareholders, etc and the counterpart to this required by all providers in order to get paid - billers, coders, compliance folks etc- is a colossal waste and does nothing to enhance access or quality of care. There has to be a more efficient and equitable system.
5
how can you not factor population into the study? France has 67 million while Switzerland only has 8 million and an overall wealthier population at that.
The clearest outcome from your 'tournament' is that the USA is the clear loser in all ways. Expensive innovation, unavailable to many who would benefit from it, is of very little benefit. Having 10% of the population without coverage, and that after spending about half again as much percentage of GDP as the rest of these countries is a shameful indictment of the pitiful weakness of the US system. Nobody, setting out to design a healthcare system, no nation in the world would design one to imitate the US system. We should be shamed to have it, we should demand better, and we should ask ourselves what could possibly motivate the Republicans who agitate and propagandize to make it even worse.
3
5 years ago I fell off a rock and broke my hip while vacationing in Ireland. An ambulance took me to the hospital. Needless to say, my biggest worry was how am I going to pay for this. I was distraught. I had no coverage in the USA. The staff at the hospital were very kind and assured me I would be ok. They replaced my hip and when it was time to leave, they asked if I could pay $600. NO other bills arriving four months later, like in the USA. $600, one bill, no B.S. Done! Jaw dropping amazing. I am grateful to Ireland, thank you!
1
As an American citizen, I had 30+ years of experience with U.S. healthcare. I then spent 10 years in France and am now going on 5 years in Switzerland. My question: why is the U.S. spending such a large percentage of GDP for far inferior results?
Hands down, France delivers the best care at the most affordable rates for individual citizens. Switzerland's health insurance rates, while slightly less expensive than in the U.S., are much higher than in France, even after paying for supplemental insurance in France. Both France and Switzerland offer truly excellent care in an easy to use system.
I am not sure why several of the contributors to this article cited innovation as more robust in the U.S. Several advancements in medical research (notably antibiotics and recent advances in cancer treatments) have come out of France and both France and Switzerland have enormous pharmaceutical industries which would suggest that they are innovating.
Bottom line, if France can deliver quality healthcare for all for less than the U.S. pays, why wouldn't you want to imitate that system?
Hands down, France delivers the best care at the most affordable rates for individual citizens. Switzerland's health insurance rates, while slightly less expensive than in the U.S., are much higher than in France, even after paying for supplemental insurance in France. Both France and Switzerland offer truly excellent care in an easy to use system.
I am not sure why several of the contributors to this article cited innovation as more robust in the U.S. Several advancements in medical research (notably antibiotics and recent advances in cancer treatments) have come out of France and both France and Switzerland have enormous pharmaceutical industries which would suggest that they are innovating.
Bottom line, if France can deliver quality healthcare for all for less than the U.S. pays, why wouldn't you want to imitate that system?
4
It's nothing but greed and inefficient management by the private owners of the health system. A public good should never be managed by greed, or at least without a heavy regulatory hand on pricing and availability.
The ideas that dominate the US market are endangering everyone in this country.
The ideas that dominate the US market are endangering everyone in this country.
1
I have had healthcare in Australia, UK, and China. China provided relatively inexpensive medical care in an emergency for say $200. Australian healthcare standards are higher than the UK. However, the UK delivers a reasonable service to a universal population. When I visit the USA I carry travel insurance.
Great article but I have two critiques. First, why not include Sweden? Secondly, the broader question is how do each of these countries support the health of their citizens? What about culture? What about agricultural and industrial policy? What about the social determinants of health? What about social security? Family leave? Social and economic inequality? Health is not simply a mater of hospitals and bills.
2
Germany's system saved my life 10 years ago. I was leaning over to pick up something off the floor and turned my head sideways. I felt something pop in my neck. I thought I had pulled a muscle or tendon. But my neck began to swell,. Our friends there offered their doctor. I refused at first. The wife came to see me. She is really why I am still here. She said, "Get in the car. Now." We went to a very large regional clinic/hospital. They admitted me when I couldn't sit up. I had two emergency surgeries on my neck, one simple and one more complex, to remove all the necrotic tissue inside. They kept me for 3 weeks, with rest, liquids, and pureed food. I could hardly swallow at first. They did many tests; dental X-rays, an MRI, blood tests, etc, but did not find a cause. When they discharged me, much improved, I received a bill at my hotel. All they charged me was what the German system would have paid; 7500 euro total, about $10,000 USD. Luckily I had it to give. Here I am 10 years later, fine. My sister-in-law is a nurse. She said 3 weeks in the hospital, 2 emergency surgeries, and all those tests would cost at least $100,000 here. The Germans were kind, helpful, very skilled, and responsible. Even the pureed food lasted good. I was never asked about money or insurance, not once--only for my name, address, and phone. To me, this what health care should be. And I am grateful to them still. So I vote for the German system.
4
I lived in Italy for 7 years, and Canada for the past year. I'm a huge fan of the Italian healthcare system vs the US, but my wife prefers the Canadian.
While in Italy, if I had a problem, I went to the local doctor, whose office was a 3 minute walk. As the point of entry, he would either prescribe medication, or refer me on to a specialist or for tests. If he deemed it urgent, he so marked it, and I had immediate attention.
While the hospitals are not as fancy as in the US (they remind me of local hospitals in the '60's, and you won't get a private room), they are spotlessly clean, the food is quite good, the staff are excellent, and the equipment is complete and modern.
For this you pay around 400 euros per year, or in my case 0 as I am over 65. There is a co-pay of 30 to 45 euros for most procedures, but doctor's visits are free. Prescription drugs are in most cases free, or a small co-pay, while generics tend to be more costly.
I loved my doctor in the US, but give me the Italian system any day.
While in Italy, if I had a problem, I went to the local doctor, whose office was a 3 minute walk. As the point of entry, he would either prescribe medication, or refer me on to a specialist or for tests. If he deemed it urgent, he so marked it, and I had immediate attention.
While the hospitals are not as fancy as in the US (they remind me of local hospitals in the '60's, and you won't get a private room), they are spotlessly clean, the food is quite good, the staff are excellent, and the equipment is complete and modern.
For this you pay around 400 euros per year, or in my case 0 as I am over 65. There is a co-pay of 30 to 45 euros for most procedures, but doctor's visits are free. Prescription drugs are in most cases free, or a small co-pay, while generics tend to be more costly.
I loved my doctor in the US, but give me the Italian system any day.
2
PLEAE LETS GET THE INSURANCE COMPANIES OUT OF HEALTH CARE!!!!
6
I lived in Queensland, Australia. They had a Lottery to cover their health care expenses. My baby brother had eye surgery to eliminate a crossed-eye, and plastic surgery to make his outer ears more appealing. The wait time was negligible and they have incredibly talented surgeons. My opinion is that the U.S. model will never work. It allows people with money to have the "best, high-priced doctors, while the poor have Medicare. I also lived in Montana, USA. My uncle had kidney disease as a child and he and his wife moved from England to Las Vegas (where my aunt worked as a Registered Nurse). When my uncle died, they stuck my aunt with the 0ne Million dollar bill. She worked day and night over the years, and paid off the bill, but caused herself to have a massive stroke (no-one found her for days, in bed, sunk down under the covers). She was paralyzed down one side, with her arm hanging useless and it took a huge amount of rehabilitation for her to relearn how to speak, walk, feed herself, do her personal hygiene etc. She is deceased now, but I don't have to tell you her opinion of the US health care system, or her family's.
1
What this shows is that there are models out there we can use to improve our "health care" system. Therefore if we don't or, more accurately, if our elected officials can't be bothered to, we know that our health is not important, the money is more important. And our often praised ingenuity is non-existent.
2
I read this in hope of a clear winner based on agreed criteria. I was disappointed. Countries were not judged against the same criteria. A gridded checklist would have provided a better comparison than this odd pairing. The responses were -to me - inconclusive. Moreover, systems were judged not a little on how well they might work in the US. Look at this statement: "Like every country here except the U.S., Switzerland has a universal health care system, requiring all to buy insurance." Well, that is not the case. IN Australia we are not compelled to buy insurance, nor are the British, the Germans, the Canadians. What do others think? The idea is nice, asking for our participation, but the comparison was all over the place, US-centric, and just didn't give me any idea of which was best, or why. Personally, I think the Aussie system the best, esp.after a trip to the Us where my stepson and I had to lift an aging woman up the stoop to her home, after a taxi dropped her off - she had just had a hip replacement, had been released from hospital and could not walk, let alone negotiate steps. SO much for health care in the US, I thought. This would never happen in Aust. Every Aussie has full and free access to the hospital system across Australia. Now, my little rambling anecdote reminds me of this woolly, random comparison of health systems. I think it is just about as conclusive.
2
Lets get real. The US allows drug companies to advertise to consumers. All told with reps and with the cost of such ads and lack of research because of the huge budgets drug companies allocate to advertising and the cost hike that cannot be avoided by Congressional law, the cost is a good fraction of a trillion dollars which results in no better healthcare, possibly worse, with a huge cost burden. So there is no real debate. Any healthcare system would be much less expensive and effective without this cost.
And there is a direct link to the opioid epidemic in the US (only) because Purdue Pharma, incorrectly as it turns out but with no repercussions, convinced doctors to treat pain like high blood pressure or other measurable indicator with opioids which have questionable value as pain relievers (drug companies invented something called "pain receptors" to replace the idea that the brain actually has opioid receptors and no "pain receptors" to describe how this highly addictive pain treatment would work. The cost of the opioid epidemic, started by a drug company pushing pain pills, has exceeded a trillion dollars. Again this is only a US problem.
A trillion dollars here and a trillion dollars there and pretty soon you get into thinking that really the best way to lower healthcare cost and get to universal coverage that is affordable is to rethink the whole notion of ads being "protected free speech" no matter how destructive to society.
And there is a direct link to the opioid epidemic in the US (only) because Purdue Pharma, incorrectly as it turns out but with no repercussions, convinced doctors to treat pain like high blood pressure or other measurable indicator with opioids which have questionable value as pain relievers (drug companies invented something called "pain receptors" to replace the idea that the brain actually has opioid receptors and no "pain receptors" to describe how this highly addictive pain treatment would work. The cost of the opioid epidemic, started by a drug company pushing pain pills, has exceeded a trillion dollars. Again this is only a US problem.
A trillion dollars here and a trillion dollars there and pretty soon you get into thinking that really the best way to lower healthcare cost and get to universal coverage that is affordable is to rethink the whole notion of ads being "protected free speech" no matter how destructive to society.
2
In the US, you can go bankrupt, literally, from medical costs, even though you have health insurance. I doubt that this is true of any other developed country. This makes it well nigh impossible to do any realistic retirement planning in this country.
1
It's So considerate to give your readers an idea of other countries health care
Programs.If we can prevent the extremists in the congress from killing us ,there are ideas here to make universal health care possible for all of us.it only requires discussion and compromise.
Programs.If we can prevent the extremists in the congress from killing us ,there are ideas here to make universal health care possible for all of us.it only requires discussion and compromise.
Hats off to the NY Times for making an attempt to describe the healthcare systems of some other countries. I wonder how the "voting" would have turned out without the potential bias/opinions of the so-called experts on the panel. The US does poorly (last) on the Commonwealth Fund report and has for some time. That's the only opinion that counts. Having access to affordable comprehensive health insurance, by whatever system, is the key to good health outcomes. The US fails miserably.
1
Canada did not create its health insurance system all at once.
Hospital insurance started in 1957. Private or employer-funded insurance was rare; hospitals had lots of unpaid bills. The Federal government offered cost sharing to any province that launched a plan that was 1. comprehensive, 2. universal, 3. portable, 4. had no financial barriers to access and 5, was publicly administered on a non-profit basis. All provinces participated quickly.
In 1967, (Canada's Centennial), having provided federal assistance for welfare, post-secondary education, and a public pension plan, the federal government offered cost-sharing for physicians' services. The same 5 conditions applied.
Provinces were reluctant to join. Some had plans for low-income people to get insurance (à la Medicaid). Employer health insurance plans were common. Doctors offered an insurance plan. When the federal government levied an income tax surcharge, most provinces caved in, but it took 4 years.
Insurance companies continued to offer health insurance, as "designated agents". Thus they could keep in touch with clients and sell other products. But after 2-3 years, they all abandoned the role. It wasn't worth it.
Long term care, home care, are partially funded by the Feds; dentistry not at all. As a result, coverage varies from province to province.
Canada doesn't have a single payer sytem; each province does.
No other country's model is easy to transplant. Times and circumstances matter.
Hospital insurance started in 1957. Private or employer-funded insurance was rare; hospitals had lots of unpaid bills. The Federal government offered cost sharing to any province that launched a plan that was 1. comprehensive, 2. universal, 3. portable, 4. had no financial barriers to access and 5, was publicly administered on a non-profit basis. All provinces participated quickly.
In 1967, (Canada's Centennial), having provided federal assistance for welfare, post-secondary education, and a public pension plan, the federal government offered cost-sharing for physicians' services. The same 5 conditions applied.
Provinces were reluctant to join. Some had plans for low-income people to get insurance (à la Medicaid). Employer health insurance plans were common. Doctors offered an insurance plan. When the federal government levied an income tax surcharge, most provinces caved in, but it took 4 years.
Insurance companies continued to offer health insurance, as "designated agents". Thus they could keep in touch with clients and sell other products. But after 2-3 years, they all abandoned the role. It wasn't worth it.
Long term care, home care, are partially funded by the Feds; dentistry not at all. As a result, coverage varies from province to province.
Canada doesn't have a single payer sytem; each province does.
No other country's model is easy to transplant. Times and circumstances matter.
1
Austria should have been mentioned (though I believe Germany is quite similar). (I’m a doctor, US expat, practiced in NY and Austria) Mandatory state-sponsored and -administered health insurance for all, premiums scaled to income, affordable for all, extra private insurance available. Public and private hospitals and doctors. High level of care, easily equal to the US. As a high earner, I paid high premiums, but never so high as to hurt. For the past 10-15 years I’ve had various bad luck (always turned out well, so far), and needed a lot of hospital care and check-ups, all in the same public hospitals, and with the same doctors and technologies, as everyone else (except I have a private room), and all for nothing. My care has already cost more than I ever paid - and no risk of being cancelled. Even with my savings, the cost of all this would have been a huge strain, and in the US it would have broken most people’s backs. A GI endoscopy here costs no more than 1/10th the usual US big-city price. People over 50 get free preventive colonoscopies at least every 10 years, more and earlier if indicated. Meds are covered, too, of course. Finally, inordinately long waits for care are almost unheard of, with some few exceptions, e.g., some imaging studies. Sure, most doctors here don’t earn nearly as much as most do in the US, but we all live at comfortably, at worst, and can’t complain. The system’s not perfect, for sure, but the US, even the UK, would be shamed by comparison.
Because I have experienced fantastic health care outside of the US, I can say that Canada/BC, in particular, offers an excellent system that more than met my needs & provided the very best care I could've received anywhere &--in my humble opinion, because of the circumstances in which the care was delivered--far, Far better had it happened here. There was no rush to discharge, doctors were kind/respectful, generous in being attentive, available; all was covered--everything. No treatment anywhere, in my opinion, could've been better. I also witnessed first hand how having total coverage allowed all resident citizens of BC to live in comfort [NOT FEAR] of knowing all their needs, medications included, were part of their coverage. Additional insurance was also available & in some cases, provided patients with surgeries somewhat quicker.
Health care is a right--a basic human right, not unlike "life, liberty & the pursuit of happiness" simply because without healthcare, those tenets we hold so dear, are not available, or at least not for very long. Unless Obamacare/ACA or medicare/medicaid for all is made available for ALL resident citizens of this country, regardless of ability to pay, we will continue to offer the best possible care money can buy--just like in our elections we put the best politicians money can buy in office. Is it possible we might learn there are better ways to live? to run a country?
Health care is a right--a basic human right, not unlike "life, liberty & the pursuit of happiness" simply because without healthcare, those tenets we hold so dear, are not available, or at least not for very long. Unless Obamacare/ACA or medicare/medicaid for all is made available for ALL resident citizens of this country, regardless of ability to pay, we will continue to offer the best possible care money can buy--just like in our elections we put the best politicians money can buy in office. Is it possible we might learn there are better ways to live? to run a country?
1
I live in British Columbia. Some years ago I broke my neck in a motor vehicle accident in Washington state. I received excellent treatment and had the comfort of knowing that my BC government health insurance would cover all expenses, even out of country. I was, however, taken aback when the first person I met in the emergency ward had a clipboard and was asking me how I would pay for all this. I had never before faced this question.
My roommate in the hospital, who had broken his back, had no such luck. This young man, about 30, was trying to adjust to the fact that he would never walk again. But he spent about two hours being questioned about such things as whether he owned a car, a boat, a stereo. While facing the greatest trauma of his life, the priority of the hospital appeared to be how they could clean him out as a the cost of care. I cannot believe this had a therapeutic benefit.
As the "competition" showed, there are many ways to reach an equitable goal and to provide health care at an affordable cost for the population, But to find one of those routes is a social imperative. I note that the favourable comments given to the US system were on the basis of the continuation of the ACA. I wonder where the US would place if Republicans succeed in repealing it.
My roommate in the hospital, who had broken his back, had no such luck. This young man, about 30, was trying to adjust to the fact that he would never walk again. But he spent about two hours being questioned about such things as whether he owned a car, a boat, a stereo. While facing the greatest trauma of his life, the priority of the hospital appeared to be how they could clean him out as a the cost of care. I cannot believe this had a therapeutic benefit.
As the "competition" showed, there are many ways to reach an equitable goal and to provide health care at an affordable cost for the population, But to find one of those routes is a social imperative. I note that the favourable comments given to the US system were on the basis of the continuation of the ACA. I wonder where the US would place if Republicans succeed in repealing it.
2
The problem with the US system is not the actual delivery of care to patients. The problems lie with our work culture and our for-profit medical insurance.
The US work culture is the antithesis of promoting health. At a time when many Americans can't afford basic human necessities, CEO pay outstrips worker compensation by a ratio of 271:1. However, workers are expected to work at least 40 hours per week in roles that are detrimental to vitality. All for the privileged of paying exorbitant fees for employer-sponsored insurance.
Sitting stationary day in and day out is damaging to the musculoskeletal system and the cardiovascular system. My hunch, is that staring at a computer screen is also less than optimal for cognitive functioning but I have not seen research in this area.
Throw in stagnating wages that put more and more families into the "Dual Income Trap" and you have a situation that leads to limited time for families to prioritize health with appropriate nutrition and activity.
Then for-profit insurance companies make clinical decision in the name of making money. I know, as I work for one. My spouse is an MD. Frequently, MBAs in insurance companies, driven by profit, are the ones making the medical decisions.
Like most things in America, it becomes incredibly clear WHY we have this system once you understand that that it functions to exploit workers for the gain of the 0.1%.
If we untether insurance from work, how can profiteers live lavishly off of our backs?
The US work culture is the antithesis of promoting health. At a time when many Americans can't afford basic human necessities, CEO pay outstrips worker compensation by a ratio of 271:1. However, workers are expected to work at least 40 hours per week in roles that are detrimental to vitality. All for the privileged of paying exorbitant fees for employer-sponsored insurance.
Sitting stationary day in and day out is damaging to the musculoskeletal system and the cardiovascular system. My hunch, is that staring at a computer screen is also less than optimal for cognitive functioning but I have not seen research in this area.
Throw in stagnating wages that put more and more families into the "Dual Income Trap" and you have a situation that leads to limited time for families to prioritize health with appropriate nutrition and activity.
Then for-profit insurance companies make clinical decision in the name of making money. I know, as I work for one. My spouse is an MD. Frequently, MBAs in insurance companies, driven by profit, are the ones making the medical decisions.
Like most things in America, it becomes incredibly clear WHY we have this system once you understand that that it functions to exploit workers for the gain of the 0.1%.
If we untether insurance from work, how can profiteers live lavishly off of our backs?
2
Since moving to Switzerland five years ago I've had to get used to going to the doctor, pharmacy, or hospital and paying nothing. People are saying its "expensive" but compared to the US, its nothing. You can have the best healthcare insurance for 250 USD per month with 2500 USD deductible for the year. After you hit your deductible, you pay 10%. Its what US healthcare could and should be.
I am a U.S. citizen living in the U.K. with my British-born wife who has dual U.S./U.K. citizenship. We are both retired and caring for my wife's elderly mother. Our income is from modest pensions and Social Security with a small amount of savings. Once my mother-in-law passes (she's 96) we shall decide where we want to live out our days. While we would like to return to the States to rejoin family and friends, the fact is that the cost of healthcare in America compared to free coverage here with the National Health Service means that the decision has to be that we stay in the U.K. Gladly, we like it here.
2
I almost stopped reading the rest of this article when Britain beat Canada... What looks good on paper does not necessarily translate to better in practice and outcome. The better judge or criteria would be the actual state of health of the people served by the respective systems. There are many possible measures- longevity, oral health (DMFT measures)- the WHO publishes stats that measure and rank these same countries. Switzerland is on top on longevity, the Germans have less caries on their teeth compared to everyone else. No surprise that the US is dead last among your short list on both these measures.
2
btw I am an American living in Germany- I've lived in the Philippines and Australia- I have a sister in Singapore who until last year lived in Switzerland, I have another sister in the UK. We compare health care quality and costs- and the sad conclusion is the US lags way behind in both and it shows in people's wellness.
I'm British living in Britain. For me the idea that if I were ill and needing professional help then I'd have to start thinking about money "can I afford to accept treatment?" is bizarre. And harsh.
Over here, we get sick = we get free treatment, plain and simple. The level of care isn't perfect, especially under this austerity-addicted Tory government, but nothing is perfect in life.
Of course it's not really 'free' as I pay my taxes and National Insurance. But the idea that I may pay more over a lifetime than I recoup in treatment expense (hopefully) doesn't make me feel cheated, it makes me feel proud to be part of the broader solution.
If you'll forgive me for saying so, the U.S. system (and others) has a sense of selfishness to it. And no wonder when the motive – rather than trying to be caring, cooperative beings – is to maximise shareholder return. The profits (massive public-to-private wealth transfer, which the U.S. excels at) enjoyed by big pharma and insurance firms from people's misfortune is, quite frankly, unconscionable.
Your country seems to have lost your sense of 'together'. Rather, it looks like 'everyone for themselves'. The healthcare argument about "innovation" is surely a red-herring when so many of your citizens are suffering in precarious conditions.
Am I being naive?
Over here, we get sick = we get free treatment, plain and simple. The level of care isn't perfect, especially under this austerity-addicted Tory government, but nothing is perfect in life.
Of course it's not really 'free' as I pay my taxes and National Insurance. But the idea that I may pay more over a lifetime than I recoup in treatment expense (hopefully) doesn't make me feel cheated, it makes me feel proud to be part of the broader solution.
If you'll forgive me for saying so, the U.S. system (and others) has a sense of selfishness to it. And no wonder when the motive – rather than trying to be caring, cooperative beings – is to maximise shareholder return. The profits (massive public-to-private wealth transfer, which the U.S. excels at) enjoyed by big pharma and insurance firms from people's misfortune is, quite frankly, unconscionable.
Your country seems to have lost your sense of 'together'. Rather, it looks like 'everyone for themselves'. The healthcare argument about "innovation" is surely a red-herring when so many of your citizens are suffering in precarious conditions.
Am I being naive?
120
You're not being naive at all. You're spot on with your assessment of our health quagmire. I wouldn't call it "everyone for themselves" but rather me, me, me and the rest can get buggered. As an American who has lived in Israel and Italy, both countries that have some form of Universal Healthcare, it still boggles my mind to this day when people say that they don't want their healthcare payments going to help the "poor". It's unconscionable and totally lacking in humanity and empathy.
5
Agreed - thanks Jonathan.
A French colleague also found it bizarre that, even with insurance, we have lots of costs so many of us worry first about money when a health issue arises. I tried to help a guy who was riding a bicycle and was hit by a car, and he told me not to call an ambulance because he had no insurance. Terrible indeed.
1
When I was on vacation in Havana in December, I got something in my eye and I had to go to a clinic. I was nervous, because I really don't speak much Spanish. Coming from the United States, I was also nervous about how much it would cost. "Cuanto," I asked with trepidation. In the end, it was $20 CUC. The equivalent of about $22 dollars. I'm pretty sure they thought I was crazy for being so happy, as that is a fair amount of money in Cuba. I was then taken to another room and was seen by a doctor. He looked into my eye with equipment likely from the seventies. He then used a cue tip to remove the dirt from my eye. It was more old-style treatment than I'm used to, but it worked. The eyedrops cost 15 CUC and I was free to go. In all, I spent about $38 on something that would have been free if I was a Cuban citizen. In the US this would have cost me about $10 at a clinic, but it also might have cost an uninsured person $70 or $200 or any other arbitrary price. If Cuba--a country the current US government apparently thinks is crawling with corrupt, insidious communists--cares enough about its citizens to ensure that they have equal and free access to healthcare, why can't the United States? I know the answer to this question lies in taxes, but I for one would gladly pay more taxes to get a healthcare system like the ones described in this article, where the patient is treated for little or no cost. If Western Europe can do it, and even Kyrgyzstan and Cuba, shouldn't we?
1
I have indeed paid for medical care in a foreign country when my wife took a fall in Mexico requiring an ambulance trip of over 60 miles and an entire day in a fee-for-service hospital where the care was what I would expect in the USA, maybe better. The total bill was a little over $800.00. Similar costs here in SoCal would have exceeded $20,000 according to my insurance company at that time and they gladly reimbursed me for the full $800.
I hear complaints about, "my taxes this and my premiums that", well your taxes may go up but your premiums may decrease significantly for a large offset of the tax increase.
My premiums have gone up every single year since I've had employer sponsored coverage to a point where my contribution is now almost $750/month for my wife and I. Oh, my former employer - I am retired - pays and equal or greater amount. This is insanity with no end in sight.
What the Republicans are trying to do now will affect every...single...American because all of the rules will change, even the rules for those of us with employer sponsored plans. Anyone who thinks otherwise is a fool or a liar.
I hear complaints about, "my taxes this and my premiums that", well your taxes may go up but your premiums may decrease significantly for a large offset of the tax increase.
My premiums have gone up every single year since I've had employer sponsored coverage to a point where my contribution is now almost $750/month for my wife and I. Oh, my former employer - I am retired - pays and equal or greater amount. This is insanity with no end in sight.
What the Republicans are trying to do now will affect every...single...American because all of the rules will change, even the rules for those of us with employer sponsored plans. Anyone who thinks otherwise is a fool or a liar.
1
This is exactly the kind of debate I need to see. I pay ridiculous taxes and I pay exorbitant insurance rates. Between them I spend half of my income for services I get little of. I really need to know if the rest of the world has a better way or not. My trips to the hospital have been checkered with commentary about what I can't have because insurance companies don't allow this , or that. If I have to pay and pay, I would at least like the best. If Switzerland, which I've never heard about before, has a better system and costs the same , or less. I want it. I'd also like a lot less money spent on drugs and something spent on cures.
28
Woah Woah, you think because you come to Switzerland "everything" will be covered? It would be no different then the US. Not better or worse. On a baseline policy you will get baseline - good quality but with limits - coverage. And buying insurance in Switzerland is complex. I was denied coverage for semi-private hospital room, even though this is taken for granted in the US. So in Switzerland I have coverage for the "general ward". I find this scary.
I lived in Germany for thirteen years and have lived in Switzerland for a total of nineteen years.
I have found both systems excellent, although my experience in Germany goes back 30 years, so I can't offer an opinion on medical care there today. An extremely important aspect for me are medical outcomes. I have been seriously ill for the last nine months and the medical care I have had in Zurich is tops. I'm very impressed by it. Interestingly, most of my doctors are from Germany, since their level of earnings appears to be higher in Switzerland than in their home country.
My experience with medical care in the U.S. is, that if you live in the New York metropolitan area, or another major metropolitan are, you can find excellent medical care, provided you can pay for it. If you live in small-town America, the picture appears to be much different, for example, footage of people waiting in line in the rain for doctors to come and set up a "medical fair" so they can get any kind of treatment at all.
I have found both systems excellent, although my experience in Germany goes back 30 years, so I can't offer an opinion on medical care there today. An extremely important aspect for me are medical outcomes. I have been seriously ill for the last nine months and the medical care I have had in Zurich is tops. I'm very impressed by it. Interestingly, most of my doctors are from Germany, since their level of earnings appears to be higher in Switzerland than in their home country.
My experience with medical care in the U.S. is, that if you live in the New York metropolitan area, or another major metropolitan are, you can find excellent medical care, provided you can pay for it. If you live in small-town America, the picture appears to be much different, for example, footage of people waiting in line in the rain for doctors to come and set up a "medical fair" so they can get any kind of treatment at all.
2
I lived and worked in Australia in the early 70s. I had a number of baffling health issues that American doctors could not resolve. All were diagnosed in an eye blink when I moved to Australia. Furthermore health insurance was incredibly cheap there. If needed, I could have had brain surgery for $25! I can't speak highly enough of the quality of health care in Australia.
"Some judges took a global view, giving the edge to countries, like the United States, that promoted innovation that benefited the rest of the world. In other cases, how health systems treated the poorest of society was paramount."
The US does promote innovation, but based on profitability, not health. We're 13th in the world in longevity, let alone healthy longevity. We don't make health insurance available to our own poorest, let alone do research into the diseases, like malaria, that kill so many people in "the poorest of society".
US healthcare is run by the pharmaceutical and medical device companies. Long ago in 2001, nearer the beginning of the disaster, the editors of 12 of the most influential medical journals issued a joint statement about the commercial takeover of medical research. Former editors have described their publications today as "marketing arms for the pharmaceutical industry." Physicians, let alone patients, can't reasonably trust "research" paid for by the companies selling the drugs. Articles in the same medical journals that doctors read conclude clearly (no surprises here) that sponsored studies are over 5 times more likely to reach conclusions favorable to the drug involved.
80% of Vioxx and Celebrex sold in the US, even though thrombosis/heart attack was a known "side" effect even before the drugs went to market. Why not, since most of the "expert panels" that set guidelines, as well as much of the FDA, is made up...you know. statinvictims.com
The US does promote innovation, but based on profitability, not health. We're 13th in the world in longevity, let alone healthy longevity. We don't make health insurance available to our own poorest, let alone do research into the diseases, like malaria, that kill so many people in "the poorest of society".
US healthcare is run by the pharmaceutical and medical device companies. Long ago in 2001, nearer the beginning of the disaster, the editors of 12 of the most influential medical journals issued a joint statement about the commercial takeover of medical research. Former editors have described their publications today as "marketing arms for the pharmaceutical industry." Physicians, let alone patients, can't reasonably trust "research" paid for by the companies selling the drugs. Articles in the same medical journals that doctors read conclude clearly (no surprises here) that sponsored studies are over 5 times more likely to reach conclusions favorable to the drug involved.
80% of Vioxx and Celebrex sold in the US, even though thrombosis/heart attack was a known "side" effect even before the drugs went to market. Why not, since most of the "expert panels" that set guidelines, as well as much of the FDA, is made up...you know. statinvictims.com
3
I can only comment on my daughters experience of having her son at a maternity unit in NYC compared to her peers here in UK and my own, many years ago. I'm shocked at the lack of anti and post natal care provision, the standard of what is available and the cost is out of reach of many ordinary people in US. Mothers are left unsupported and many will struggle if no family support network available. No Health visitors, no community midwife access, no Mother and baby clinics to pop into, weekly if required, for a chat and reassurance. I really think US woman and babies get a very poor deal and it breaks my heart. At least in Africa if one of the major charities set up a field hospital women could walk, two days if necessary, to access some basic care that is free. For a first World country you have third world maternity provision in my opinion. Sorry if this offends but you did ask.
5
Based on personal experience with the German Healthcare System and my sister's personal experience with the Swiss Healthcare System : The winner is Germany. As Mr. Reinhard noted: The Swiss system is less equitable than many other European systems, including Germany’s.
What the NY Times left out:
Both system use competing non-for-profit private companies (that is the key) that are heavily regulated.
A highly regulated non-for-profit company is an efficient compromise construction between a government single payer system ( not exposed to competition) and between a free market of competing , unregulated, for profit , health insurance companies.
What the NY Times left out:
Both system use competing non-for-profit private companies (that is the key) that are heavily regulated.
A highly regulated non-for-profit company is an efficient compromise construction between a government single payer system ( not exposed to competition) and between a free market of competing , unregulated, for profit , health insurance companies.
36
In Germany for 25 years employed. Fully covered. For most monolingual Americans language is a barrier.
Never a co-pay. An unheard of rip-off .
With small monthly addition, also complete dental.
Never a co-pay. An unheard of rip-off .
With small monthly addition, also complete dental.
Love it. I've never understood why a co-pay is required. Are we buying the doctors coffee or lunch. They need cash or a tip?
I've now lived a bit over half my life in several Canadian provinces, currently Quebec, and the rest in the US, mainly in Pittsburgh, Pennsylvania. Unfortunately this means that I've probably seen the best of the US system and the worst of the Canadian one, and so without outside knowledge I'd be ill-equipped to judge them.
The worst parts of the Canadian system have almost nothing to do with the public health insurance system, which is basically invisible from the patient's point of view. I do not miss paying co-pays, having a deductible, getting Explanation of Benefits letters or mysterious bills for amounts that were undisclosed to me when I had a test or procedure done. If you pay for something done privately here, the price is known up front (you might even have to pay cash). I appreciate that everyone has, in theory, the same access to care.
There are two big problems in the Canadian system, which are particularly acute in Quebec - the funding mechanism for the 100% public part of the system is broken, and the licensing system for practitioners leads to a scarcity of primary care. Basically it boils down to the money does not follow the patients, so you can't get a primary care doctor in the most populous regions, and nobody answers the phones at the hospitals. Because the government has been captured by the doctors' lobby (PM and health minister of Quebec were both highly paid specialists before politics) there is little hope of change.
The worst parts of the Canadian system have almost nothing to do with the public health insurance system, which is basically invisible from the patient's point of view. I do not miss paying co-pays, having a deductible, getting Explanation of Benefits letters or mysterious bills for amounts that were undisclosed to me when I had a test or procedure done. If you pay for something done privately here, the price is known up front (you might even have to pay cash). I appreciate that everyone has, in theory, the same access to care.
There are two big problems in the Canadian system, which are particularly acute in Quebec - the funding mechanism for the 100% public part of the system is broken, and the licensing system for practitioners leads to a scarcity of primary care. Basically it boils down to the money does not follow the patients, so you can't get a primary care doctor in the most populous regions, and nobody answers the phones at the hospitals. Because the government has been captured by the doctors' lobby (PM and health minister of Quebec were both highly paid specialists before politics) there is little hope of change.
Move to France. No seriously, as a dual national (US-FRA) living in Iowa I face the prospect of being uncovered in Iowa after December 2017. The Iowa individual market has crated. I am losing my coverage at work. Will I have to move to France as a health care refugee?
28
I lived in Colombia for 20 years. On paper, Colombians have a constitutional right to health care, but in reality, access depends on money and location. Access and provision of health care is better the more money you have, and is better if you live in a big city. If you live in a rural area, health care is generally bad to non-existent. The health care system is the model for Obamacare with a subsidized regime, and a employer/employee payment regime and a system of HMOs (called EPS). Long lines and waiting times are common, bureaucratic delays for expensive treatments are common, and transfers from clinic to clinic are also common. Colombia does have a legal procedure called a tutela, sort of like a court order for action, by which a patient can get the expensive treatment despite the bureaucratic shield. This is very good for the country's lawyers who outnumber the underpaid doctors. Still, it is much better to have the right to healthcare than no right except the right to pay and die.
Health care is not a commodity like coffee or shoes or cars. It should not be left to the vagaries (and greed) of the so-called free market. It is a basic human need. The U.S. ranks so low in most measures of good health care, compared to the rest of the industrialized world, that it's shocking. We have THE most expensive health care yet far from the best.
It's way past time for single-payer, or Medicare for all, or however one wants to name it. People talk about socialized medicine, as if that's a bad thing. My good friends in France still have doctors who make house calls; my good friends in Britain have doctors who maintain their good health, not just "fight disease," and when they have an issue, they're right there at the head of the line, not waiting and waiting (as some would have you believe). And we're all at that age where things fall apart.
Single payer now!
It's way past time for single-payer, or Medicare for all, or however one wants to name it. People talk about socialized medicine, as if that's a bad thing. My good friends in France still have doctors who make house calls; my good friends in Britain have doctors who maintain their good health, not just "fight disease," and when they have an issue, they're right there at the head of the line, not waiting and waiting (as some would have you believe). And we're all at that age where things fall apart.
Single payer now!
2
I am always surprised by the bias of Anglo saxon wworld against countries like France, Italy or Spain. It is rare that in positive international comparison you focus on them. It is always about UK, Canada, Germany or Sweden. Is it a language thing? More info available in English? I n previous NYT articles on health systems I didn't see the French system being mentioned which seems so strange to me given how good of a balance between public and private sector it is.
That being saidt, this time it was and the voters (not the panel) rightly chose the French model over the Swiss one. Having experienced both it is a close call but I think the French system is clearly better at dealing with the flexibility required for a non homogeneous and larger population.
That being saidt, this time it was and the voters (not the panel) rightly chose the French model over the Swiss one. Having experienced both it is a close call but I think the French system is clearly better at dealing with the flexibility required for a non homogeneous and larger population.
Health Insurance CANNOT work as 'private' - when you have 2 separate health insurance systems, private and public, those you can pay 'the rich', who are more often the 'healthy' choose 'private' and the poor, who are more often the sick choose 'public', so the government bears the 'poor' folks, with bad healthcare, and the 'private' companies benefit from the rich, because of their lower spending. THIS IS WHAT HAPPENS IN THE US. WHEREAS the rich need to subsidize the poor so there is a larger risk pool (which is what happens in Germany, Uk, Canada, and all single payer systems). It's a very simple idea and this is only possible in a single payer system.
I am always dismissive of claims by defenders of our system that other systems, such as the Canadian system, can result in wait times or delays in receiving some treatments.
This position reflects an elitist attitude. For those without private insurance or extemely high deductibles, economic factors prevent ill people from seeking service in the first place. In which case, the wait times and delays are infinite.
This position reflects an elitist attitude. For those without private insurance or extemely high deductibles, economic factors prevent ill people from seeking service in the first place. In which case, the wait times and delays are infinite.
8
I just don't understand why healthcare has to be a for-profit enterprise? How is it that we are able to provide excellent K-12 education to the entire population? As with the healthcare systems outlined in this article, these countries are able to provide healthcare to everyone at relatively low cost. Americans pay more just in stress by itself wondering how or if they will be able to buy the healthcare they need. It seems positively barbaric that people literally die because they can't afford the healthcare they need. I am a small business owner with a decent income but live in a very expensive city. I can barely afford the healthcare premiums I must pay, and because of very high deductibles I literally never go to the doctor besides my one, free annual check up. How can this possibly be OK in the richest country in the world?
2
As I literally just finished typing an appeal letter to my insurer in Switzerland for a rejected claim, I need to point out some MAJOR flaws in the Swiss system. 1) Insurance is really expensive, with high deductibles, and co-insurance on top of that, I'm 40 and I pay around $490, and my husband at age 47 pays another $300 for useless coverage with a high deductible. The employer contributes nothing. 2) We have to pay out of pocket for all services except hospital stays and surgeries up front - that's right, bills come in the hundreds and thousands of francs and you need to front that cash, before submitting your bills to your insurance company yourself and waiting 60 days on average for reimbursement, if you get reimbursed at all because they denied your claim, which they often try to do just like in the U.S. for profit system. 3) The coverage is not great, no dental options, no infertility treatment, hearing aids, or glasses, no birth control coverage etc. 4) Hospitals aren't that nice and you can't even have your obgyn deliver you without complementary insurance. Private clinics are nice ones yes - ahhh but you pay more for that coverage, they can deny you for "complementary insurance" based on pre-existing conditions and you'll have a CHF 500 deductible to pay first, and a copay of 50.00 per outpatient visit if you try to use those benefits. So...in truth, the Swiss system is a for profit system, offering lousy options to subscribers at a high cost with much aggravation.
My wife and I traveled to Europe last fall and stayed for about six weeks. During that time my wife developed a severe chest cold and we decided seek treatment while Seville, Spain. We walked to a private hospital, entered the emergency room, and were informed that the cost would be $85 to be seen by a doctor. After a less than five minute wait, we were called into a consultation room where the doctor was actually waiting for us. After a thorough examination, the doctor wrote prescriptions for an antibiotic, some Ibuprofen 600 capsules, and a decongestant which we filled at a local Farmacia for $14. All of that took less than an hour and we were on our way. If it was the U.S., we'd still be getting bills from the hospital, and from doctors we'd never seen. It was an altogether pleasant experience.
8
I went into an Emergency room for a horrid toothache four months ago. Just looking for relief from the pain. Getting to the doctor took three hours and reams of paperwork and copays and credit cards and insurance cards. Misdiagnosed the abscess separate three times and gave me a prescription for drugs I could have gotten OTC. $1500.00 later and I was in worse shape than when I went in. Flew (with a toothache the doctor swore I didn't have) to England. Had a root canal that day and was out of pain.....for nothing. They had me sign a single paper when I left and THEY THANKED ME!
1
I lived in Spain for 3 years and the access, quality and cost were all top notch (and I went to the hospital a few times for biking related accidents). I did not wait in lines. I did not have to fill out a lot of paperwork. I did not have bills that were confusing. I was in an out. I live in Connecticut now and would pay a "premium" in my tax rate to eliminate the hassle of the U.S. health care system. Just making sense of how much I owe for a simple emergency room visit is a research project in the U.S. (much less dealing with "in-network" docs who I would not otherwise choose). My time is more valuable than that.
Additionally, many claim that the U.S. is the hub of innovation in health care. That may be the case, but the poor outcomes stats in the U.S. relative to other developed nations would suggest that those innovations are not helping people. In any case, we can let the private sector handle the innovation like we do with every other industry. Plenty of investors would fund innovative solutions for complex health care cases, which are the minority, not majority of cases. A comprehensive formulary, right to go to any doc, standardization across the system and low administrative hassle is what I think is valuable.
Additionally, many claim that the U.S. is the hub of innovation in health care. That may be the case, but the poor outcomes stats in the U.S. relative to other developed nations would suggest that those innovations are not helping people. In any case, we can let the private sector handle the innovation like we do with every other industry. Plenty of investors would fund innovative solutions for complex health care cases, which are the minority, not majority of cases. A comprehensive formulary, right to go to any doc, standardization across the system and low administrative hassle is what I think is valuable.
2
Although American free-market capitalism is great for many industries, it is a terrible fit for health care. A fair market requires knowledgeable consumers but patients usually don't have the time or background to be truly knowledgeable consumers of health care services; they have to trust their doctors. In a fair market the providers compete for business but in health care the professionals ideally act cooperatively and collegially. A fair market is driven by profit and return on investment but chronically sick, elderly, and dying patients are unlikely to be good investments; that isn't the point of health care. Market influences have given us a system riddled with self-referrals, little kickbacks, and outrageous price lists that are five times higher than expected payments. A smaller role for the free market almost surely would be an improvement. -- Steve Ingels, MD
58
" A fair market is driven by profit and return on investment but chronically sick, elderly, and dying patients are unlikely to be good investments"
Exactly - this is the single biggest argument for universal health care. Current system leaves out people who need it the most.
I am fortunate enough to have retiree healthcare provided by my former employer, the state of North Carolina. The insurance is excellent; however, our current Republican State Treasurer along with the Republican majority legislature is proposing to pay providers less. That would mean that many providers would be out of network, making it more expensive for the insured. Republicans always seem to want to cut any expenditure that helps the people. This is one reason I haven't been a Republican for many years.
1
And once again every single expert consulted is male. Have we not yet learned that women's voices are important in the health care debate? You can do better than this, NYT!
3
Another facet of the French system that promotes access, wellness and overall better healthcare outcomes, as well as reducing costs, is "long term afflictions" coverage. Medical acts/prescription drugs for diseases that one has for his/her lifetime, such as diabetes, MS, heart disease, etc. are reimbursed at 100% of the system's reimbursement scheme, as opposed to 70% for other medical acts (and the 2ndary insurance picking up that balance). This has provided peace of mind to me (heart disease) and my spouse who has MS.
Another misconception that I read in some commentary is the notion that our system does not pay when one seeks care in private clinic/hospital settings. Nothing could be further from the truth. I required a surgical intervention to remove bone spurs that were strangling a nerve in my lower spinal column. A top notch neurosurgeon in a private clinic performed the surgery. The only fee that exceeded the conventional reimbursement rates was the "packaged" fee of the neurosurgeon. It was 200 Euros above the system's rate. My secondary insurance contract picked up the difference.
Another misconception that I read in some commentary is the notion that our system does not pay when one seeks care in private clinic/hospital settings. Nothing could be further from the truth. I required a surgical intervention to remove bone spurs that were strangling a nerve in my lower spinal column. A top notch neurosurgeon in a private clinic performed the surgery. The only fee that exceeded the conventional reimbursement rates was the "packaged" fee of the neurosurgeon. It was 200 Euros above the system's rate. My secondary insurance contract picked up the difference.
7
The studies do an excellent job of comparing FUNDING of medical,care. What is not covered well is the COST of care in each system. I would postulate that the cost of health care delivery in the US is much higher than in other nations, even though their outcomes usually surpass ours. We have an relatively unregulated system wherein the same procedure and drugs can cost multiple times here than in other countries. Until we get that under control, it doesn't matter much who pays for the care.
4
Re: Comments: The best health care system
I have both French and American passports. Resident and taxpayer in France for 40 years, and long-range snowbird for several years (Yuma AZ). Adherent to the French health care system, but pretty much ignorant of all the others except the American, since I followed the Obamacare debate quite closely.
I believe that the most important aspect of any effective / efficient system is something that I never hear in the American conversation: the payer (single or multiple, public or private) must have no role whatsoever in medical decisions. The payer should only learn of a medical act on receiving an order (not request) to pay. This eliminates all the administrative costs, disputes, and delays related to "prior accord". (The French system is very nearly paperless.)
I would underscore the absurdity of permanently linking health care (or retirement) to an employer. It's logical for the employer to contribute, once a contribution has been made, there is no need for the link to exist.
Also... Americans should understand the tranquility of spirit that truly universal health care (and retirement) brings to a population. People have worries... but not about losing everything because of an illness.
I have both French and American passports. Resident and taxpayer in France for 40 years, and long-range snowbird for several years (Yuma AZ). Adherent to the French health care system, but pretty much ignorant of all the others except the American, since I followed the Obamacare debate quite closely.
I believe that the most important aspect of any effective / efficient system is something that I never hear in the American conversation: the payer (single or multiple, public or private) must have no role whatsoever in medical decisions. The payer should only learn of a medical act on receiving an order (not request) to pay. This eliminates all the administrative costs, disputes, and delays related to "prior accord". (The French system is very nearly paperless.)
I would underscore the absurdity of permanently linking health care (or retirement) to an employer. It's logical for the employer to contribute, once a contribution has been made, there is no need for the link to exist.
Also... Americans should understand the tranquility of spirit that truly universal health care (and retirement) brings to a population. People have worries... but not about losing everything because of an illness.
93
Fact 1: Healthcare is complex.
Fact 2: Complex systems are best managed in an open and transparent marketplace, which is why communism failed.
Fact 3: Relying on third party payers or reimbursed pay removes the consumer from the marketplace and destroys it.
Fact 4: Healthcare should be about health. But the all the systems discussed profit only when people are sick and that is putting the emphasis on the wrong sy-la'-ble.
A system that realizes these facts would empower the consumers with funded–where necessary–HSAs, and despite the cost of 36%, when it can be used for education, housing, savings, and other socially beneficial expenses, Singapore's unified fund is pretty cheap and more attractive to all. And expanding our VA system would apply pressure to lower hospital costs as well.
People do make better decisions when they have a sense of coherence–Antonovsky demonstrated that years ago–and focusing on the elements that enhance that sense–manageability, understanding, and meaningfulness–would make us healthier as a nation.
Much of this could be done by empowering our Public Health Service to provide the education and community centered groups that share information on how to cope with specific conditions–like Tom Insel is trying to do with mental illness. Such communities could also be used properly and effectively to study the effects of specific treatments that are not profitable for the pharmaceutical industry like oral rehydration and the nasal use of xylitol.
Fact 2: Complex systems are best managed in an open and transparent marketplace, which is why communism failed.
Fact 3: Relying on third party payers or reimbursed pay removes the consumer from the marketplace and destroys it.
Fact 4: Healthcare should be about health. But the all the systems discussed profit only when people are sick and that is putting the emphasis on the wrong sy-la'-ble.
A system that realizes these facts would empower the consumers with funded–where necessary–HSAs, and despite the cost of 36%, when it can be used for education, housing, savings, and other socially beneficial expenses, Singapore's unified fund is pretty cheap and more attractive to all. And expanding our VA system would apply pressure to lower hospital costs as well.
People do make better decisions when they have a sense of coherence–Antonovsky demonstrated that years ago–and focusing on the elements that enhance that sense–manageability, understanding, and meaningfulness–would make us healthier as a nation.
Much of this could be done by empowering our Public Health Service to provide the education and community centered groups that share information on how to cope with specific conditions–like Tom Insel is trying to do with mental illness. Such communities could also be used properly and effectively to study the effects of specific treatments that are not profitable for the pharmaceutical industry like oral rehydration and the nasal use of xylitol.
2
I lived in Britain for a year, and while the healthcare was free, the government keeps costs down by providing inadequate coverage to people who are disabled or chronically ill. (The system may be good, but the devil is in the details.) Interestingly, while third world countries were not discussed in this article, I received excellent care during my five years in Latin America. Public hospitals were free, private doctors were not expensive (they made house calls!), and doctors were much better at listening to patients and making accurate diagnoses. (Also, pharmaceuticals were cheap.) They don't have a lot of bells and whistles in most Latin American hospitals, but my experience there was infinitely better than my encounters with the medical system in the US, which is not only horrendously expensive, but quite poor at delivering basic care.
Reading the comments herein which overwhelmingly support any other country's health care system to the United States begs the question: How can Americans be so stupid? Yes, stupid. Americans love to boast whenever they go abroad how great America is, how it has the best of everything. Yet when you talk with them about their country's history, from Slavery to the Civil War, to Civil Rights, to Health Care they look at you dumbfounded. Sure, they'll confess, the US has made mistakes, we all do, yet when presented with facts and figures comparing how different countries handle a particular problem they get all jingoistic on you, citing somer perverse version of American Exceptionalism. They apparently learn nothing, from engaging in a land war in Southeast Asia, which has beaten the best for centuries, yet Americans truly believe they will produce a different outcome, to their current war, their longest in history, in Afghanistan, which no nation in history conquered, yet they still talk the talk of an impotent imperialistic power whose clout is on the wane.
The United States can top all the countries listed in health care if they put their minds to it. Yet when it comes time to get involved, half of them do not even bother voting. Can you imagine how ignorant one must be to not at least every four years exercise a right millions have died to preserve. America, you have met the enemy, it is you.
DD
Manhattan
The United States can top all the countries listed in health care if they put their minds to it. Yet when it comes time to get involved, half of them do not even bother voting. Can you imagine how ignorant one must be to not at least every four years exercise a right millions have died to preserve. America, you have met the enemy, it is you.
DD
Manhattan
7
At least the Russians voted in our elections. Maybe they can get us a single payer option for our next president?
1
This is a silly exercise.
You can either compare the disease care results in different nations or not.
A listing of nations by different outcome measures exists, produced by the World Health Organization. The U.S. Scores rather low on this listing in most areas.
The U.S. has the highest expenditures in the "health" care sector, among the world's nations.
So, both in terms of our quality and our costs, our national nonsystem is a flop.
But the article doesn't emphasize that.
Instead, it pictures this issue as a sports contest.
Talk about not seeing what's right in front of you.
Stupid and sad.
Stephen Rinsler, MD
You can either compare the disease care results in different nations or not.
A listing of nations by different outcome measures exists, produced by the World Health Organization. The U.S. Scores rather low on this listing in most areas.
The U.S. has the highest expenditures in the "health" care sector, among the world's nations.
So, both in terms of our quality and our costs, our national nonsystem is a flop.
But the article doesn't emphasize that.
Instead, it pictures this issue as a sports contest.
Talk about not seeing what's right in front of you.
Stupid and sad.
Stephen Rinsler, MD
8
An anecdote I should have included yesterday in my comparison of the French "Assurance Maladie" to my US Medicare coverage, especially in light of the Equifax data hack:
In the last 3 years, my data has been compromised in hacks by 2 US hospitals and by my secondary health insurer (the largest BC/BS administrator in the US).
In France I do not need to worry about my identity being compromised unlike it has been on so any fronts in the USA.
In the last 3 years, my data has been compromised in hacks by 2 US hospitals and by my secondary health insurer (the largest BC/BS administrator in the US).
In France I do not need to worry about my identity being compromised unlike it has been on so any fronts in the USA.
2
I am an American living in Germany, and over the last 7 years I am consistently satisfied with the quality and costs related to healthcare here, which is unfortunately, something I never could say about Healthcare in the US.
My feeling is that Healthcare here is truly and primarily focused on patient health. My impression of US Healtcare was that their primary focus was profitability.
One of the biggest positives is that "additional" bills related to healthcare, outside of the normal monthly payments, are either ZERO or nominal. We are obliged to pay 10% for perscriptions, but for children, nothing. A few years ago, I had a knee injury that resulted in surgery. I recieved excellent care before and after the surgery, including Rehabilitation and physiotherapy. My 6 month recovery cost me less than 100 EUR out of pocket.
How can we have gotten it so wrong in the US? If others can do it, why can't we?
My feeling is that Healthcare here is truly and primarily focused on patient health. My impression of US Healtcare was that their primary focus was profitability.
One of the biggest positives is that "additional" bills related to healthcare, outside of the normal monthly payments, are either ZERO or nominal. We are obliged to pay 10% for perscriptions, but for children, nothing. A few years ago, I had a knee injury that resulted in surgery. I recieved excellent care before and after the surgery, including Rehabilitation and physiotherapy. My 6 month recovery cost me less than 100 EUR out of pocket.
How can we have gotten it so wrong in the US? If others can do it, why can't we?
5
Having lived in FIVE countries and experienced major healthcare issues in all of them, I would DEFINITELY pick Australia's.
For my annual Medicare levy of $376, I got all my doctor visits, tests, xrays, and a four-day hospital visit and major operation with NO OTHER OUTSIDE COSTS (and GREAT care!).
New Zealand, Czech Republic and Scotland all very good also (didn't have as extreme health issues in any of them).
In the US? Almost identical operation that I got in Australia: ONE DAY in hospital (barely 24 hours), sent me home, took 2 months to recover (after operation in Australia I was able to teach the next week) and the charge, on top of the $17K my insurance company was billed, was $4000 to me.
For-profit (USA) healthcare vs Not-FOR-Profit (everywhere else :/ ).
For my annual Medicare levy of $376, I got all my doctor visits, tests, xrays, and a four-day hospital visit and major operation with NO OTHER OUTSIDE COSTS (and GREAT care!).
New Zealand, Czech Republic and Scotland all very good also (didn't have as extreme health issues in any of them).
In the US? Almost identical operation that I got in Australia: ONE DAY in hospital (barely 24 hours), sent me home, took 2 months to recover (after operation in Australia I was able to teach the next week) and the charge, on top of the $17K my insurance company was billed, was $4000 to me.
For-profit (USA) healthcare vs Not-FOR-Profit (everywhere else :/ ).
3
I agree with your findings. I am American and live in Switzerland, and I am diabetic. Everything is covered at 90% after my 300 chf yearly deductible. My insulin costs are about $10 a month. I don't understand why Americans put up with their costs. Insulin has been around for 90 years or so.
2
The VA provides care to patients at a cost that is significantly lower than private hospitals.
It does this through paying a salary to all workers including physicians and secondly by eliminating the "hotel" environment in hospitals.
US could offer VA style healthcare to all as part of its universal health care pledge with those who want more luxurious settings paying for it through private insurance.
It does this through paying a salary to all workers including physicians and secondly by eliminating the "hotel" environment in hospitals.
US could offer VA style healthcare to all as part of its universal health care pledge with those who want more luxurious settings paying for it through private insurance.
2
Did anyone factor in productivity costs? If you can't get your diabetes under control etc you are missing a lot of work. Life expectancy? Isn't US life expectancy going down? How about stress. If you can go from middle class to bankrupt with one expensive illness that adds up to a lot of stress. Seems the US would loose big time if those factors were added in. So how about innovation that is supported but not withheld from everyone below the wealthiest of the world's citizens.
5
Reading some of the comments, I am starting to think that I and some of the people I know in the UK have just been unlucky with quality of care. My experience with ease of access (I had health insurance) and quality of care was excellent in the US compared with my experience and what I read about in the UK. Common conditions (eg, cancer, osteoporosis) can go undiagnosed for ages here. It can take weeks/months to get an appointment for something so simple as a hearing test. Medical errors have caused someone I know to land in intensive care twice. Patients are sometimes sent home by trainee doctors when they should still be in hospital.
What good is healthcare that is free at the point of care if it poor quality or dismissive.
What good is healthcare that is free at the point of care if it poor quality or dismissive.
1
I lived in few countries that provide universal healthcare. However, I am surprised that they didn't include Israel which has an outstanding totally free healthcare system for Its citizens. My experience is that, most industrialized countries have decent and comparable healthcare systems. The US does provide excellent care provided individuals have health insurance provided by the employers. This leaves most American citizens without healthcare which is exorbitantly expensive. The US has to step up to the plate and do something to provide health services for all its citizens. We have a very unhealthy nation which puts us at risk as a matter of national security.
I think your analysis of the French health care system was a bit cursory and the vocabulary used reflects the way the system is perceived in the United States, rather than how this obligatory, but consensual system is perceived in France. No one in France would say that they “buy” their national health insurance, which covers about 70 to 80 percent of care. Payment for coverage is taken out of employees’ salaries at source. Many companies also offer access to voluntary health insurance, which covers most of the rest. The national public health care “tax” is based on income. But there is a cap, above which income is not taxed. It is illegal to use “previous conditions” in the calculation of premiums paid for the voluntary part of health insurance.
Every person in France, including illegal immigrants, is entitled to medical coverage. This is seen in France as a public health concern, since it is agreed that illegal immigrants’ health care issues can affect the general welfare of the population at large.
There is general consensus in France, across party lines, that the system must be kept in place, even if successive governments have tweaked it to reflect concerns of rising costs.
I have had experience with both the American and the French systems. To my mind the average French person has a better chance of getting access, through the French system, to scientific innovations resulting from American research than the average American has, and at a lower cost.
Every person in France, including illegal immigrants, is entitled to medical coverage. This is seen in France as a public health concern, since it is agreed that illegal immigrants’ health care issues can affect the general welfare of the population at large.
There is general consensus in France, across party lines, that the system must be kept in place, even if successive governments have tweaked it to reflect concerns of rising costs.
I have had experience with both the American and the French systems. To my mind the average French person has a better chance of getting access, through the French system, to scientific innovations resulting from American research than the average American has, and at a lower cost.
3
You conclude by saying that this should be the start of "honest" discussion but that is impossible in this country because of the Republican Party. All you have to do is look at the latest last ditch effort (if only) to repeal the ACA and "who knew it could be so complicated".
Also, including Taiwan in your comparison would have been good. Their system is highly regarded. My son and his family live there and their health care is very impressive. Our granddaughter was born there, prenatal care etc was excellent. We were visiting once when our daughter-in-law was admitted for abdominal pain and possible appendicitis. The care was again excellent and the cost was $30 because my son paid for a private room for her for the three days that she was in the hospital. The other thing I noticed was that everyone who worked at the hospital seemed happy.
Also, including Taiwan in your comparison would have been good. Their system is highly regarded. My son and his family live there and their health care is very impressive. Our granddaughter was born there, prenatal care etc was excellent. We were visiting once when our daughter-in-law was admitted for abdominal pain and possible appendicitis. The care was again excellent and the cost was $30 because my son paid for a private room for her for the three days that she was in the hospital. The other thing I noticed was that everyone who worked at the hospital seemed happy.
I spent most of my life in the US, but have lived in Switzerland for the past 10 years. I am a big fan of the Swiss health care system. In my experience, access here is world-class. I can almost always get a same-day appointment at my Primary Care physician, and he goes way out of his way to be customer focused. Waiting times for specialists and facilities are also short, and basically zero if the problem is urgent. The mandatory basic care is still quite comprehensive. You only give up things like private hospital rooms and some choice of physicians while hospitalized. For those who can afford it, supplemental insurance to cover things not in the basic package is quite reasonably priced, certainly by US standards. There is LOT of competition among the basic insurers, a high percentage of Swiss change insurance companies every year, based on cost but also on customer service criteria. There is an excellent web service to help comparison shop.
The only downside that I see is that the costs are quite a bit higher than our neighboring countries (though that is true for everything else from food to housing to automobiles). Still well below costs in the US, though.
The only downside that I see is that the costs are quite a bit higher than our neighboring countries (though that is true for everything else from food to housing to automobiles). Still well below costs in the US, though.
1
I live in CH as well. Never a wait for anything. No insurance company "approval" hassles. Just superb health care.
We lived and worked in the UK for 7 years and were covered under the NHS. In general our healthcare was better in the UK than in the US. We had co-workers who suffered serious health problems that were treated well and promptly. Upon our return to the US, the first question from a potential new clinic was "how will you pay" The quality of care in the US is directly proportional to your ability to pay. I experienced that when my husband was diagnosed with terminal cancer. We were fortunate, a catastrophic medical plan at a reasonable cost from our employer and Medicare were instrumental in the type of care he received. What wasn't covered (new drug treatments) under Medicare were covered by the catastrophic plan. We're a wealthy country but have more emphasis on wealth than health.
2
American living now with the Swiss system of care. I pay 338 CHF per month with a 1500 CHF deductible. The basic insurance I pay is about 260 per month, and a lot of preventative procedures do not fall under the deductible. The rest of the costs are for extra insurance, which covers things like emergency healthcare abroad, alternative therapies like massages (they pay 70% from certified therapists, no prescription required!), glasses/contact lenses, wellness and gym memberships, etc.
The downside in Switzerland is that having universal access to coverage means that more people are using the doctor, which is causing insurance premiums to increase every year. Right now the country is trying to figure out how to better control rising costs, such as encouraging telemedicine as a treatment option (you call a doctor when you're feeling sick instead of going to the office; the doctor can refer specialists or prescribe medicines over the phone).
This article talks a lot about the ACA trying to emulate the Swiss system, but it won't begin to be effective until Americans decouple health insurance from employers. This severely restricts choice and creates a market imbalance between supplier and buyer. In Switzerland, I choose my own private insurer and have the option to change it once a year if I find a better price or service elsewhere. It stays with me even if I lose my job.
The downside in Switzerland is that having universal access to coverage means that more people are using the doctor, which is causing insurance premiums to increase every year. Right now the country is trying to figure out how to better control rising costs, such as encouraging telemedicine as a treatment option (you call a doctor when you're feeling sick instead of going to the office; the doctor can refer specialists or prescribe medicines over the phone).
This article talks a lot about the ACA trying to emulate the Swiss system, but it won't begin to be effective until Americans decouple health insurance from employers. This severely restricts choice and creates a market imbalance between supplier and buyer. In Switzerland, I choose my own private insurer and have the option to change it once a year if I find a better price or service elsewhere. It stays with me even if I lose my job.
I pay about 800 a month for my wife and I here in CH, but with a 300 chf a year deductible (or so, might be 350)
Health-care providers hold all the cards, and nowhere, in the developed world, is this more apparent than in the United States, or less so than in Greece.
Greece ranks first among OECD countries in the number of practising physicians per 1000 population, 4.9; with Belgium a distant second, 4.0; and the US trailing at 2.4. Easy access to doctors means easy access to diagnosis, to drugs, and to hospital beds in Greece. Rationing of care by US doctors (fast if you are rich, slow if you have decent insurance, and never mind if you are poor) means difficulties in access to all the other aspects of medical care. No wonder that very wealthy doctors are a common phenomenon in America, but not in Greece. Medical bankruptcies, frequent in the US, are almost unheard of in Greece.
The difference between health-care outcomes in Greece and the US is especially telling. The Greek health system was ranked 9th among major countries, in the World Health Organization's rankings, ahead of those of the Netherlands, Britain, Switzerland, Belgium, Sweden and Germany, with the US behind Saudi Arabia, Morocco, Chile and Costa Rica, among others.
Greece also held its rank, in the middle, among the 19 developed countries studied, in terms of Mortality Amenable to Health Care, i.e. preventable deaths in 2002-2003. The US fell, from a previous study, to last place.
Greece ranks first among OECD countries in the number of practising physicians per 1000 population, 4.9; with Belgium a distant second, 4.0; and the US trailing at 2.4. Easy access to doctors means easy access to diagnosis, to drugs, and to hospital beds in Greece. Rationing of care by US doctors (fast if you are rich, slow if you have decent insurance, and never mind if you are poor) means difficulties in access to all the other aspects of medical care. No wonder that very wealthy doctors are a common phenomenon in America, but not in Greece. Medical bankruptcies, frequent in the US, are almost unheard of in Greece.
The difference between health-care outcomes in Greece and the US is especially telling. The Greek health system was ranked 9th among major countries, in the World Health Organization's rankings, ahead of those of the Netherlands, Britain, Switzerland, Belgium, Sweden and Germany, with the US behind Saudi Arabia, Morocco, Chile and Costa Rica, among others.
Greece also held its rank, in the middle, among the 19 developed countries studied, in terms of Mortality Amenable to Health Care, i.e. preventable deaths in 2002-2003. The US fell, from a previous study, to last place.
I've used the health care systems of Indonesia, India, the UK, Israel, New Zealand, Afghanistan, Jordan, Australia, and the U.S.. I've had inpatient hospital treatment in India (public hospitals in Goa and Ootacamund and Kolkata), in Afghanistan (Kabul), Hawai'i (Kaiser Honolulu), California (Kaiser Oakland), and New Zealand. Trying to evaluate and compare the health systems of such diverse array of jurisdictions is impossible with referencing what one is evaluation. For example, the incredible generosity and compassion that I received in India which at the time was one of the poorest nations in the world and despite my spending a total 8 weeks as an inpatient, nobody every asked me for any money, any ID, a credit card, an insurance card .... nothing. But they gave me everything they had without question despite my coming from a wealthy nation and having no status other than as a visitor. That is something I will never forget and it's been difficult ever since to forgive our nation's lack of generosity and compassion when it comes to accessing medical services.
2
My wife is from Canada. From my perspective, the very first step that Americans must take is the recognition that health care is a right, not a privilege. Canadians have achieved this. Even asserting flaws, wealthy Canada citizens acknowledge the need for their system. Here in the U.S., it remains a form of social Darwinism. We have lost our sense of shared sacrifice and are fighting over the scraps now.
3
I wish these analysis would factor in the general health of the population that the health care system has to deal with. My observation is that, on average, people in France and Switzerland have much better diet and exercise habits than people in the US. When you consider that 75% of healthcare spending in the US is for chronic diseases like diabetes and heart disease - which are mostly caused by poor diet and exercise habits - it seems obvious why we spend so much more on healthcare with worse outcomes.
Unlike many who participate in these debates, I've actually lived and made use of healthcare in three of the countries discussed. I was born in Canada and lived there for 30+ years, then moved to the USA and then later to the UK.
I appreciate that many of the arguments given are objective and perhaps even academic. However, speaking as a consumer of healthcare, my experience is that the USA is so poor as to not even be worth considering. Yes, the lottery of a big win does motivate Big Pharma in the USA - but if US healthcare did not operate in that weird manner, are we to believe all innovation in medical research would stop?
Given my experiences, I would choose the British system of the three I have personal experience with. Out of all the systems covered, I would choose France (I have researched living in France, so have perhaps better than average familiarity). While I have plenty of good stories to tell about the Canadian and UK systems (which usually end with "And it didn't cost a cent!) I can also tell some that illustrate the frustrations and inefficiencies of the US non-system - many ending in "And despite the fact that I had full insurance, it still cost me $2700 and three weeks of arguing on the telephone every lunch hour!"
I appreciate that many of the arguments given are objective and perhaps even academic. However, speaking as a consumer of healthcare, my experience is that the USA is so poor as to not even be worth considering. Yes, the lottery of a big win does motivate Big Pharma in the USA - but if US healthcare did not operate in that weird manner, are we to believe all innovation in medical research would stop?
Given my experiences, I would choose the British system of the three I have personal experience with. Out of all the systems covered, I would choose France (I have researched living in France, so have perhaps better than average familiarity). While I have plenty of good stories to tell about the Canadian and UK systems (which usually end with "And it didn't cost a cent!) I can also tell some that illustrate the frustrations and inefficiencies of the US non-system - many ending in "And despite the fact that I had full insurance, it still cost me $2700 and three weeks of arguing on the telephone every lunch hour!"
2
Any of the systems compared here are better than what we have in the U.S. And with the latest legislation afoot, if successful, will be even worse!
In the U.S., it is moving more and more in the direction, "only the wealthy deserve to be healthy".
Also, one of the biggest issues in the U.S., is what providers and drug companies charge in the first place! These are the root of what is driving the cost of insurance coverage and is spiraling out of control. But no one is even touching that side of the issue at all!
In the U.S., it is moving more and more in the direction, "only the wealthy deserve to be healthy".
Also, one of the biggest issues in the U.S., is what providers and drug companies charge in the first place! These are the root of what is driving the cost of insurance coverage and is spiraling out of control. But no one is even touching that side of the issue at all!
1
I am 61, earn $51k per year, and have to spend $833 per month on a mediocre BCBS Omnia Silver policy, with a $2500 deductible and mostly $50 copays. How can someone survive this kind of healthcare, when they tell you who you can see and what drugs you can and cannot take? My private insurance company is making a profit off my misery. I do not understand how in what is supposed to be the greatest country, people have to bankrupt themselves if they get sick, all for insurance companies to make a profit and pay their executives outrageous salaries, at my expense. The every man for himself country. Like we've gone back to the Wild West. I hate what we have become. Capitalism has hijacked democracy.
8
Just a point of clarification about what was written about Singapore's healthcare system ("Singapore’s workers contribute 36 percent of their wages to mandated savings accounts").
The 36% referred to is the total contributions made to a person's Central Provident Fund account, something only Citizens and Permanent Residents have (the figure is presently 37% for those under 55 years of age, by the way). Only 20% of that total comes from the worker's salary - the other 17% comes from their employer. These deductions are automatic if one is a salaried employee earning above a threshold amount, but self-employed individuals have to make their own top-ups to their account. A CPF account comprises three sub-accounts: an Ordinary Account, Special Account, and Medisave Account. Only 8-10.5% gets diverted to one's Medisave account from the total (employee + employer) contribution.
A more accurate figure to reflect in your article as forced healthcare savings would therefore be that 8-10.5% of a worker's salary (which includes a percentage contribution from their employer).
https://www.cpf.gov.sg/employers/employerguides/employer-guides/paying-c...
https://www.cpf.gov.sg/members/schemes/schemes/healthcare/medisave
The 36% referred to is the total contributions made to a person's Central Provident Fund account, something only Citizens and Permanent Residents have (the figure is presently 37% for those under 55 years of age, by the way). Only 20% of that total comes from the worker's salary - the other 17% comes from their employer. These deductions are automatic if one is a salaried employee earning above a threshold amount, but self-employed individuals have to make their own top-ups to their account. A CPF account comprises three sub-accounts: an Ordinary Account, Special Account, and Medisave Account. Only 8-10.5% gets diverted to one's Medisave account from the total (employee + employer) contribution.
A more accurate figure to reflect in your article as forced healthcare savings would therefore be that 8-10.5% of a worker's salary (which includes a percentage contribution from their employer).
https://www.cpf.gov.sg/employers/employerguides/employer-guides/paying-c...
https://www.cpf.gov.sg/members/schemes/schemes/healthcare/medisave
5
The idea that health care is a for profit business is greed personified. The media does not accurately report on the subject because the health industry is a huge spender in advertising. Check out the breakfast news and see why the US system is based on exploitation rather than providing care.
I have lived in the UK, Spain, France and Japan. All systems are superior to the US health system, which is purely pay to play and is immoral.
I have lived in the UK, Spain, France and Japan. All systems are superior to the US health system, which is purely pay to play and is immoral.
2
Excellent article. I've experienced the healthcare systems in Britain, Germany and France- all are SUPERIOR to the US in terms of cost, access and lack of bureaucracy. I only wish that all five of your experts weren't male...it wouldn't have been too hard to find a qualified female doctor. Wake up NYT.
8
How the Times could have ignored Japan in this comparison is incredible. Japan has a record of best outcomes, universal coverage and reasonable cost that puts it at the best in the world. Its system is based on cost controls, an idea alien to the greed-based paradigm in the USA.
4
where are the Nordic countries?......considering that Denmark in particular was often mentioned in recent political debates on this issue why would you leave them out of the discussion?
3
Living in Prague, I wonder if Germany doesn't have worse care than Switzerland due to the influence of east German doctors. Doctors who were educated under communist rule, at least in the Czech Republic, often have very poor/esoteric educations. I studied education at uni here and while there is a younger generation of academics which is fiercely fighting for standards, some of the older psychology professors seamed to think that Freud was modern and the four humors were "the basics".
Another problem with the analysis, is the comparison as a percentage of GDP. Germany has a MUCH lower GDP per capita (41,936USD) than Switzerland (78,812.65 USD), thus the truth is that the Swiss system is not just a little more expensive. It is more than twice as expensive! Switzerland also has more equity per capita than any other country (so lending is very cheep there!).
Another problem with the analysis, is the comparison as a percentage of GDP. Germany has a MUCH lower GDP per capita (41,936USD) than Switzerland (78,812.65 USD), thus the truth is that the Swiss system is not just a little more expensive. It is more than twice as expensive! Switzerland also has more equity per capita than any other country (so lending is very cheep there!).
2
I share the general opinion in the UK, that the NHS is a wonderful system. At present it needs more money from the government to maintain quality, but even as it is it is a wonderful thing to know that illness does not mean bankruptcy. I split time between UK and France. The French system is not bad, but I prefer UK
2
Interesting. Is this possibly because you are more familiar with the UK system? I've approached both from a newcomer's perspective and would (slightly) prefer the French system - not that I have any complaints about my personal NHS experience
We now know that more than a third of American voters have an unenlightened mentality that would embrace a compromised character like Donald Trump.
The continued existence of this relatively powerful group of poorly educated Americans does not inspire hope for the country.
The deteriorating public education system will continue to crank out students who are unprepared to assume civic responsibilities. This group's influence will hold the country back from true progress in health care as well as maintaining a large middle class!
The continued existence of this relatively powerful group of poorly educated Americans does not inspire hope for the country.
The deteriorating public education system will continue to crank out students who are unprepared to assume civic responsibilities. This group's influence will hold the country back from true progress in health care as well as maintaining a large middle class!
2
I was quite disappointed that Spain was not included. Ask any British tourist about our system and...look at the data. Spain does rank better than the UK (according to The Lancet)
I have lived in Germany, France and the UK. They all have excellent systems. But in Spain care is much faster, which is important if you have cancer.
I have lived in Germany, France and the UK. They all have excellent systems. But in Spain care is much faster, which is important if you have cancer.
4
I am a German national and had my first baby in UK and the second in Switzerland. You make it a small difference but in my experience the Swiss provision is much much better. In the UK the midwives looked more tired than me after giving birth, they were stretched so thin. The pain medication I was given is not even offered in Switzerland because the side effects are too bad, it made the Swiss giggle. The epidural on offer in UK was the one that immobilises you completely, in Switzerland you can have the version where you regulate your own dose. If you want you can stay 3-4 days in hospital with your newborn in Switzerland after a normal birth to recover, whereas in UK you get thrown out after 6 hours as long as you can walk. Of course, outcome was the same: two healthy babies (hurray!), but the patient experience is a big difference.
2
I have lived in both France and Australia, though before they put the two-tiered system into place there. Both gave me care and outcomes better than I could possibly imagine getting here and for no out-of-pocket expense. Contrary to what Americans seem to think, doctors are far from underpaid. We have to get over this insanity and put single payer in place ASAP!
2
I'm french, my wife is german. I studied and worked in France, worked in the US (NYC 5 years, my wife gave birth there), in Germany (also 5 years) and lately Switzerland (10 years).
First, I'm surprised how "dogmatic" the evaluation is made by a panel of judges who do not seem to have any "field" experience ...
Personnally, I cannot give an opinion on how all four healthsystems work TODAY, but I experienced them all in the last 30 years.
US : extremely expensive, depends very much on the doctor you have (religious beliefs, level of research, etc.), quick (but depends on how much money you're ready to invest), poor "hotel" environement (Beth Israel at the time was a horriblle place, but it probably depends on the hospital)
France : accessible to all, some good to very good doctors (but you have to pay extra if you want to have access to top level, through private practices, not reimbursed), long waiting times (MRI for instance, one to two months' wait is common), a service quality which is sinking due to low wages, infrastructures are aging (low investment due to huge debt).
Germany : more expensive than France, very professional, easy access, good infrastructures. However, Germany is today facing large lacks of staff. They are recruiting in the eastern (Poland) and southern (Spain) EU countries despite language barriers.
Switzerland : BY FAR the best. Expensive but no debt, ie sustainable. Extremely professional and efficient, 24/7 service by local doctors, MRI within a week.
First, I'm surprised how "dogmatic" the evaluation is made by a panel of judges who do not seem to have any "field" experience ...
Personnally, I cannot give an opinion on how all four healthsystems work TODAY, but I experienced them all in the last 30 years.
US : extremely expensive, depends very much on the doctor you have (religious beliefs, level of research, etc.), quick (but depends on how much money you're ready to invest), poor "hotel" environement (Beth Israel at the time was a horriblle place, but it probably depends on the hospital)
France : accessible to all, some good to very good doctors (but you have to pay extra if you want to have access to top level, through private practices, not reimbursed), long waiting times (MRI for instance, one to two months' wait is common), a service quality which is sinking due to low wages, infrastructures are aging (low investment due to huge debt).
Germany : more expensive than France, very professional, easy access, good infrastructures. However, Germany is today facing large lacks of staff. They are recruiting in the eastern (Poland) and southern (Spain) EU countries despite language barriers.
Switzerland : BY FAR the best. Expensive but no debt, ie sustainable. Extremely professional and efficient, 24/7 service by local doctors, MRI within a week.
1
You have to look at what really happens and not just a legal description. Americans like to quote the "longer wait times" for elective surgery in Canada, but the reality is that the "elective surgery" can be triggered anytime by simply going to Emergency whereupon the patient's doctor is phoned, appears, and executives the "elective surgery". For those who can't read between the lines, the point is that Canada has an informal mechanism that bypasses a "waiting period" that every doctor knows about and uses when convenient! In practice, Canada has shorter waiting times than the US when you consider that there are Americans for whom there are no waiting lines at all for elective surgery. What good is an innovative procedure to the 20% of Americans who can't access it?
1
And of course - rarely mentioned - is the simple fact that the 1%ers in Canada simply pop south to a US private hospital. No doubt there are even 1%er health insurance plans available "offshore"
The topic is very germane to my situation. I am still trying to figure which system I like. I am a family physician based in North Carolina but I have taken a leave absence to work in a clinic in a small town in New Zealand. The health care system is probably very similar to Australia's and navigating it has been easier than I had anticipated. It is a simpler system but at a cost. There are significant wait times for diagnostic testing, surgical procedures and referrals to specialists that I would have routinely ordered and obtained easily in the US even for Medicare and Medicaid patients. The medication formulary is very limited. The patients on the whole seem to accept this but there are growing concerns. It has been a topic debated in the recent national elections.
I don't think there is one "best" health care system. If we could incorporate the best ideas from the different systems into the present US system taking into account our unique economic and sociocultural constraints, it might be a start.
I don't think there is one "best" health care system. If we could incorporate the best ideas from the different systems into the present US system taking into account our unique economic and sociocultural constraints, it might be a start.
1
US is admittedly a mess. Too many options, Medicare, Medicaid, VA, Tricare, Multipayer, Single Payer, Overhead is eating up a lot of what we pay. Any true system would be an improvement. I don't think the AMA would stand for a program like Great Britain's. One similar to France, Switzerland or Germany would work. A choice of provider, would almost be necessary considering the US mindset. Private MD to Staff Model HMO (Kaiser) It would be nice if it included dental, optometry and other ancillary services but this is most unlikely.
You say "options" but really none of those are OPTIONS. I am 61 but I cannot access Medicare! I am relatively poor, but Medicaid is far out of reach. I never served in the US military, so I will never qualify for VA care -- true for probably 98% of all women. DItto for Tricare. Single payer? Lol -- where could I get that? I'm too old to immigrate anywhere.
Being Swiss and living in Switzerland I've grown up with mandatory health insurance. It does have many kinks and issues: ever rising premiums, many paramedical treatments are only covered through voluntary private insurance, and a few others. This has led to much political debate and in recent years even a popular initiative (NB: democratic tool where upon collecting 100'000 signatures by citizens who are allowed to vote, one can trigger a national referendum to add a provision to the Federal Constitution) which aimed to abolish the currently "private executors of public tasks" system where approx. 60 private actors provide health insurance for the whole country and replace it with one public service. Because financing was a mess and Swiss voters are mostly conservative on these issues, they upheld the current system (rightly so in my opinion).
My point is, the Swiss system isn't perfect, far from it, but even when challenged, it remained. The most problematic issues are the costs which are becoming prohibitive for some low-income families which don't qualify for subsidies, but I don't believe this would have changed with a fundamentally different system. The costs reflect medical progress and a documented excess of unnecessary hospital visits, both of which would not change with a single public health insurer.
Also of note: you get mandatory accident insurance when you're an employee (meaning your health insurance coverage is reduced to "illnesses").
My point is, the Swiss system isn't perfect, far from it, but even when challenged, it remained. The most problematic issues are the costs which are becoming prohibitive for some low-income families which don't qualify for subsidies, but I don't believe this would have changed with a fundamentally different system. The costs reflect medical progress and a documented excess of unnecessary hospital visits, both of which would not change with a single public health insurer.
Also of note: you get mandatory accident insurance when you're an employee (meaning your health insurance coverage is reduced to "illnesses").
Throughout the article, the information presented disproves one of the most persistent lies perpetuated by those opposed to a single-payer system in the USA: that single payer mean zero choice. That is not true. In nearly every country with a single payer system, citizens are free to purchase private insurance or simply to pay for care out of pocket if they choose to do so. In England, France, Singapore and others, there is a thriving market for both private insurance and private health care delivery.
The widespread use of an option that allows people to purchase private insurance even within a single-payer system should come as no surprise to Americans since Medicare, the US version of a single-payer system for senior citizens, also leaves participants with the option of purchasing additional private insurance.
The fact that relatively few people (typically 10% - 15%) choose to purchase supplemental insurance in countries with single-payer systems does not necessarily mean it is hard to get or expensive. In most cases, it is simply an indicator that most people are relatively happy with services provided under the basic single-payer system and thus see no need for additional insurance.
The widespread use of an option that allows people to purchase private insurance even within a single-payer system should come as no surprise to Americans since Medicare, the US version of a single-payer system for senior citizens, also leaves participants with the option of purchasing additional private insurance.
The fact that relatively few people (typically 10% - 15%) choose to purchase supplemental insurance in countries with single-payer systems does not necessarily mean it is hard to get or expensive. In most cases, it is simply an indicator that most people are relatively happy with services provided under the basic single-payer system and thus see no need for additional insurance.
4
I have the good fortune of being a member of Kaiser Permanente, a non-profit preventive care provider in CA. No-cost vaccines, mammograms, etc. Easy online access to refill prescriptions, make appointments, review lab tests, confer with doctors. I have a small $10-$20.00 co-pay for office visits and minor surgery in a full-bore operating room in their new Oakland hospital/office building. I pay nothing for membership through my retirement plan. (Have no idea what the Medicare contribution may be). My 72-year-old diabetic neighbor pays Kaiser $85.00/mo. + a small office visit charge for her individual plan. That is a lot less than I hear about through ACA. They send patients to outside providers for specialty care, like heart surgery, chiropractors, or psychiatric observation.
I think for-profit insurance company intermediaries employ thousands of people to deny, delay, and scrutinize health care to reduce costs and increase profits. It may be preferable to have a system where participants/patients enroll directly with providers for most affordable, preventive services, for example, dentists, Pap smears, etc. Where necessary, taxpayer subsidies could go to the provider or reimburse the patient, rather than an insurance company. More local clinics could keep people healthier and avoid the "socialism" boogeyman.
Big-ticket items, like organ & bone transplants, could be covered by individual or group insurance policies, rather than setting up public facilities.
I think for-profit insurance company intermediaries employ thousands of people to deny, delay, and scrutinize health care to reduce costs and increase profits. It may be preferable to have a system where participants/patients enroll directly with providers for most affordable, preventive services, for example, dentists, Pap smears, etc. Where necessary, taxpayer subsidies could go to the provider or reimburse the patient, rather than an insurance company. More local clinics could keep people healthier and avoid the "socialism" boogeyman.
Big-ticket items, like organ & bone transplants, could be covered by individual or group insurance policies, rather than setting up public facilities.
2
Yes. the middle-man insurance companies have greatly increased costs and have helped perpetuate the litigation mentality which further fuels the need to have insurance. Have experience medical care in France, Israel and Croatia. All better than in the U.S. on several fronts. The U.S. is sink-or-swim. I have been fortunate to be in the swim category. Direct pay to providers would be far better for most normal care, with other insurance-type systems for major medical events.
But you are a retiree -- I can't tell if you are on Medicare or not. If so, Medicare is paying part of your premiums!
That tells us nothing about what a young person between 18 and 65 would have to pay.
Also: I had Kaiser about 30 years ago. It was so bad, my own doctors THERE told me (when I needed surgery) that "do whatever you need to -- sell your house -- borrow or steal -- to get this operation done elsewhere. Under no circumstances have it done here, the surgeons are incompetents butchers".
I had miserably awful care at Kaiser for several years. I would NEVER EVER go back, even if it was 100% free.
That tells us nothing about what a young person between 18 and 65 would have to pay.
Also: I had Kaiser about 30 years ago. It was so bad, my own doctors THERE told me (when I needed surgery) that "do whatever you need to -- sell your house -- borrow or steal -- to get this operation done elsewhere. Under no circumstances have it done here, the surgeons are incompetents butchers".
I had miserably awful care at Kaiser for several years. I would NEVER EVER go back, even if it was 100% free.
1
One of the great things about the German healthcare system is that income protection insurance is included as part of medical insurance. When I had cancer, I had nearly an entire year off work, and was paid a monthly stipend that was 70% of my normal salary. The concept of convalescence is extremely important in Germany - at the conclusion of treatment, I had a three week stay in a convalescence hospital in the Black Forest, with daily exercise classes, good food and access to physiotherapy and a psychologist. By the time I went back to work, I didn't just feel healed, I felt fantastic.
3
I have over 15 years experience with the German health care system- personally, as a parent of two and working as part of my husbands GP office. The benefits are so clear: easy access to all the needed tests and treatment in a very timely manner, no stress about which providers you can consult, very low costs- oh, and nearly 100% have coverage. When you are sick or undergoing diagnostics- you should not have to fight for tests or appointments or not be able to afford what you need as treatment. Period. The hospitals and clinics here can't compare to the US 'hotel' style and health care workers earn considerably less- but the system, in my opinion, is far superior.
3
"The hospitals and clinics here can't compare to the US 'hotel' style and health care workers earn considerably less"
This is one of the reasons why US system is too expensive.
- The essence of the German - and all other European - system is: You get what is required to cure your disease but no frills. If you want more - alright, but on your expense.
- This is the outcome of deliberate cost reduction.
- Cost cut was backed by unions. industrial organisations and politics to keep all shares of HC contribution low who have a common interest because this share is one part of wage´s on-costs and so a part of economical competitiveness. Lobby groups of physicans, phamaceutical companies rallied against cost cut campaigns a long time but couldn´t get through. Conservative politicians have enforced it - like Mr. Seehofer for example. (Never mention his name to a German physician or to a representative of the Association of pharmaceutical industry. Never!)
- In HC wages were adjusted to the general level of earnings to set limits to specific skyrocketing effects in HC.
- In general German wages are much lower than US wages because the part required for HC, retirement, unemployment and nursery is always "virtually" deducted and transferred to public or hedged private social security systems. These organisations have sufficient bargaining power and not as endangered by bankruptcy. This has nothing to do with HC specifics.
- NO system could afford US cost level on the long run.
This is one of the reasons why US system is too expensive.
- The essence of the German - and all other European - system is: You get what is required to cure your disease but no frills. If you want more - alright, but on your expense.
- This is the outcome of deliberate cost reduction.
- Cost cut was backed by unions. industrial organisations and politics to keep all shares of HC contribution low who have a common interest because this share is one part of wage´s on-costs and so a part of economical competitiveness. Lobby groups of physicans, phamaceutical companies rallied against cost cut campaigns a long time but couldn´t get through. Conservative politicians have enforced it - like Mr. Seehofer for example. (Never mention his name to a German physician or to a representative of the Association of pharmaceutical industry. Never!)
- In HC wages were adjusted to the general level of earnings to set limits to specific skyrocketing effects in HC.
- In general German wages are much lower than US wages because the part required for HC, retirement, unemployment and nursery is always "virtually" deducted and transferred to public or hedged private social security systems. These organisations have sufficient bargaining power and not as endangered by bankruptcy. This has nothing to do with HC specifics.
- NO system could afford US cost level on the long run.
1
The key here is that "health care workers earn considerably less".
I am all for that German system. But please tell me how we get millions of health care workers -- from doctors to nurses to hospital administrators -- to take a pay cut of 50-75%?
Seriously, please tell me. Because IMHO they would strike and fight like rapid weasels to keep their luxe pay and lifestyles.
I am all for that German system. But please tell me how we get millions of health care workers -- from doctors to nurses to hospital administrators -- to take a pay cut of 50-75%?
Seriously, please tell me. Because IMHO they would strike and fight like rapid weasels to keep their luxe pay and lifestyles.
1
ws: you are indeed correct. Most Americans are used to this system too -- and would be outraged at "plain" hospitals or clinics, where you don't have concierge care and luxuries. The two famous teaching hospitals in my region both underwent massive, massive rebuilding in the last 10 years -- they now have main campuses that look like something out of Star Trek or a luxurious Las Vegas hotel. Super modern, fountains, real artwork galore. They spend HUNDREDS of millions on this. My friend stayed in one of the new patient towers: she said it was better than a luxury hotel -- huge HDTV with premium cable -- gourmet food you order from a MENU 24/7 -- fancy furniture -- lake views from the 20th floor. How can you provide this, and really expect to do it "for free" or low cost??? OF COURSE it costs $5000 a day!
Would Americans accept (once again) cinder block walls, wards, semi-private rooms -- no TV, no cable -- steam table food -- waiting on long lines in bare-bones clinics? That is the $64 TRILLION dollar question, isn't it?
Would Americans accept (once again) cinder block walls, wards, semi-private rooms -- no TV, no cable -- steam table food -- waiting on long lines in bare-bones clinics? That is the $64 TRILLION dollar question, isn't it?
1
Having lived and worked in the biomedical field in a number of the chosen countries, I was interested in these experts bias, i.e. What they thought was important. Of the countries I know from living there with children, Britain can have awfully long waits for treatment, yet they thought Canada was worse. France has the best vertical penetration of science and technology (no matter who invented it, so giving the US credit for technology is too simplistic). Consumers want to choose, cheap services, immediate care especially in emergencies, and of course good care. Countries that limit costs will always win the economic war. The Times panel seemed to be slightly removed from everday concerns of the populations of each country.
2
THE most important issue isn't discussed in this article. It focuses mainly on costs, etc. THE KEY issue is: Where and under what system do the vast majority of medical advances occur that make life better for billions of people. The answer can be seen by observing such things as awards in medicine, Nobel prizes, etc. The incontrovertible fact is they occur mostly in the United States and some in Great Britain. No other country with government-run medicine creates the level of new discoveries that occur here in the US.
So, be careful what you wish for, you might get it. Can you imagine government supporting failure after failure and billions and billions in costs that today's drug companies invest to solve medical problems, find new treatments, SAVE LIVES? I can't, and the evidence says it doesn't occur elsewhere. (Minor exceptions do occur).
Invention and creation take vast amounts of brains, time and money. If there is no payoff at the end, it isn't going to happen. THINK, PLEASE. Stop emoting about some grand and glorious future where everything is free. That is the road to abject poverty.
So, be careful what you wish for, you might get it. Can you imagine government supporting failure after failure and billions and billions in costs that today's drug companies invest to solve medical problems, find new treatments, SAVE LIVES? I can't, and the evidence says it doesn't occur elsewhere. (Minor exceptions do occur).
Invention and creation take vast amounts of brains, time and money. If there is no payoff at the end, it isn't going to happen. THINK, PLEASE. Stop emoting about some grand and glorious future where everything is free. That is the road to abject poverty.
1
I believe you fail to realize the large number of treatments which have been invented overseas. Due to regulatory hurdles, most of these treatments never make it to the US and therefore you don't even know that they exist. As for the Nobel Prize, it is a political tool that has nothing to do with reality. Look what Aung San Suu Kyi is up to now.
3
You may have a somewhat distorted view of the magnitude of US dominance - there are an awful lot of successful European medical/pharma firms. Have you considered that many of these advances are a result of the enormous financial benefits available to individuals under the US approach? When I lived in New England, about half the medical professionals I encountered were Canadians - drawn to the US by the prospect of better incomes. When you consider the personalities of successful entrepreneurs, it is no wonder they prefer the US over other more-socialist "high tax" regimes. But if US healthcare operated more similarly, that effect would be reduced.
1
After living 14 years as an American expat in France under Carte Vitale national health care, I would not return to the United States and it's hit and miss approach to patient care under any circumstances.
The flexibility and choice of providers is superior to America in every category from the selection of specialists to choice of hospitals.
Long live France!
The flexibility and choice of providers is superior to America in every category from the selection of specialists to choice of hospitals.
Long live France!
7
Living in France, I can propose anecdotally that the system here is much better than the US in terms of access, services, cost, and care. Many more services are available, and as a married taxpayer with 3 kids I pay about the same in taxes as I did living in Brooklyn. Having said that, were I single, I would pay twice as much in taxes, so the system is skewed towards married families. One would argue that this is as it should be, because even aside from other aspects, economically families are bearing the cost of raising children, which will then be taxpaying members of society, and so less tax should be paid as per benefit provided. The losers in this system are the wealthy, who pay much more, but arguments have been made that this is better for society as a whole, for the rich and the poor to be closer together, and cross paths once in a while.
There are other problems, notably the crushing taxes on new business. This is the greatest impediment to growth in France. Other problems include competition in the Euro zone (particularly for farmers!), non-liquidity of the labor market, high percentage of unemployed, too much power given to the state and erosion of the principles of property rights, lack of inclusive immigration policies for Muslims (affirmative action), etc. Having said that, don't touch health care, that part works.
There are other problems, notably the crushing taxes on new business. This is the greatest impediment to growth in France. Other problems include competition in the Euro zone (particularly for farmers!), non-liquidity of the labor market, high percentage of unemployed, too much power given to the state and erosion of the principles of property rights, lack of inclusive immigration policies for Muslims (affirmative action), etc. Having said that, don't touch health care, that part works.
2
But it sounds like it "works" because of very high taxes, and putting a crushing burden on singles.
Now, you can argue "it's worth it!"
But how to do you sell that to Americans? Will they vote for raising their taxes by 300%? for a VAT on top of existing sales taxes?
Can you convince millions of doctors, nurses and hospital administrators to take 50-75% pay cuts? and you do not think they will strike or protest that?
Now, you can argue "it's worth it!"
But how to do you sell that to Americans? Will they vote for raising their taxes by 300%? for a VAT on top of existing sales taxes?
Can you convince millions of doctors, nurses and hospital administrators to take 50-75% pay cuts? and you do not think they will strike or protest that?
1
And - amazingly - France's productivity is neck-and-neck with the USA's. Despite "le pont" (taking the half-day before a holiday off in order to prepare for the holiday :-) and taking the entire month of August off, France manages to be as productive as a country where about half the population is too afraid to take even their measly 10 days annual leave
2
We have to factor non- medical issues - social determinants of health like poverty,education,housing, food, social isolation- into the quality discussion. These economists know that and we should discuss it more. The same system in different contexts can produce widely different results. Without that understanding the US may have a health system but not the level of health we would hope to have.
2
The more I read, the more I believe that the US system can't change until our expectations do. People who have Cadillac plans (who may also want single-payer and believe they want universal care) could not possibly see the same level of benefits. "Evil insurance companies" make bank now, but they aren't the main cost drivers.
-- Will doctors agree to lower pay, across the board?
-- Will hospitals accept universal budgets?
--Will we be willing to sharply limit where we receive specialty care? And longer waits?
-- Will we all accept tighter formularies, based on empirical evidence on outcomes? And tested against costs? (this goes beyond "negotiating prices.")
-- Will we accept less medicalization of ordinary life events and stresses?
-- Will we accept less frequent, if any, screening without proven survival benefits?
We can say, "Ah, France!" or whatever, but I bet the tradeoffs would be far more difficult to accomplish than we can imagine.
Let the record show that I would love to see universal care and believe deeply in a more equitable, accessible system. Recent history, however, makes me less than confident about Americans' ability to think of the collective good and to act with altruism.
-- Will doctors agree to lower pay, across the board?
-- Will hospitals accept universal budgets?
--Will we be willing to sharply limit where we receive specialty care? And longer waits?
-- Will we all accept tighter formularies, based on empirical evidence on outcomes? And tested against costs? (this goes beyond "negotiating prices.")
-- Will we accept less medicalization of ordinary life events and stresses?
-- Will we accept less frequent, if any, screening without proven survival benefits?
We can say, "Ah, France!" or whatever, but I bet the tradeoffs would be far more difficult to accomplish than we can imagine.
Let the record show that I would love to see universal care and believe deeply in a more equitable, accessible system. Recent history, however, makes me less than confident about Americans' ability to think of the collective good and to act with altruism.
3
One basic problem with these comparisons: they do not take into account differences between their patient populations. A health system with an homogenous, educated, relatively fit and healthy population, such as those in Scandinavia, Germany, Switzerland, Singapore, and to some extent, Canada, UK, and France, will have much lower costs and better outcomes than those with diverse and relatively unhealthy populations, such as the US. You are comparing apples and oranges.
I lived in the UK for 8 years. For five of those, I worked for an IT firm with a contract to computerize NHS hospitals in south England (we failed). So I got to know the NHS as a patient, as well as from the inside. The NHS is basically like a giant government-run Kaiser with two important differences: 1) GPs are separate from specialists and hospitals, unlike Kaiser where they are integrated; 2) the NHS has no competition to speak of, while Kaiser faces intense competition.
If one compares the NHS to Kaiser, the NHS loses badly. Wait times are used to ration care, there is little innovation, there is almost no integration of care, there is little preventive care, and many people I knew avoided NHS care as much as possible, leading to logjams at the ER.
The problem with the US is fee-for-service; the solution is multiple competing Kaiser-model organizations in every region. Under fee-for-service, folks make money when you get sick; under the Kaiser model, they lose money when you get sick.
I lived in the UK for 8 years. For five of those, I worked for an IT firm with a contract to computerize NHS hospitals in south England (we failed). So I got to know the NHS as a patient, as well as from the inside. The NHS is basically like a giant government-run Kaiser with two important differences: 1) GPs are separate from specialists and hospitals, unlike Kaiser where they are integrated; 2) the NHS has no competition to speak of, while Kaiser faces intense competition.
If one compares the NHS to Kaiser, the NHS loses badly. Wait times are used to ration care, there is little innovation, there is almost no integration of care, there is little preventive care, and many people I knew avoided NHS care as much as possible, leading to logjams at the ER.
The problem with the US is fee-for-service; the solution is multiple competing Kaiser-model organizations in every region. Under fee-for-service, folks make money when you get sick; under the Kaiser model, they lose money when you get sick.
5
I can't agree with your opinion on populations - it's a bit like saying "national healthcare in the US can never work because the existing system is so bad". Canada has as diverse (if not more so) population than the US, spread very thinly over huge distances, with a higher proportion of "new citizens" although this also means they tend to be younger.
I'm covered by the NHS and frequently get reminders from my doctor for free tests/physicals if I desire. I recently had a suspicious mole. I ,made a Dr's apt. on Monday, was referred to a specialist dermatologist on Wed for a Friday apt. I was seen by two specialists on Friday and given the all-clear - five days, start to finish.
I'm covered by the NHS and frequently get reminders from my doctor for free tests/physicals if I desire. I recently had a suspicious mole. I ,made a Dr's apt. on Monday, was referred to a specialist dermatologist on Wed for a Friday apt. I was seen by two specialists on Friday and given the all-clear - five days, start to finish.
3
A friend had breast cancer (early stage), received surgery to remove the tumor, radiation to treat the breast, and a drug to suppress hormones. Her total cost, at first rate hospitals in Mexico, was about $15,000. For everything, office visits, tests, biopsies, drugs, everything. In the States, the bills would have been over $60,000. There is a surplus of doctors in Mexico, which has kept prices down. And a level of personal service that would make you weep.
Policy makers need to focus on cost. And until they do, the US system will cause almost as much heartache as it solves.
Policy makers need to focus on cost. And until they do, the US system will cause almost as much heartache as it solves.
3
And how much do those Mexican doctors earn per year?
I'll bet it is around 75% less than US doctors -- maybe even less than that!
You do hit on a good idea here; there is a SURPLUS of Mexican doctors, educated at low cost by the state. Therefore, they COMPETE for business!
In the US, the AMA and medical schools hold down the number of doctors on purpose, so there are artificial shortages and doctors get paid the highest possible wages....around $250K to start, and much more at mid-career.
I'll bet not one doctor in Mexico makes anything close to this.
So...here is the catch: how do we get US doctors to work for $25-$75K a year? how do we educate so many US doctors, that we have a SURPLUS and they must COMPETE for patients?
NOTE: any change in their luxe, luxe lifestyles and any threat to their incomes, and doctors will strike and fight like enraged rapid weasels.
I'll bet it is around 75% less than US doctors -- maybe even less than that!
You do hit on a good idea here; there is a SURPLUS of Mexican doctors, educated at low cost by the state. Therefore, they COMPETE for business!
In the US, the AMA and medical schools hold down the number of doctors on purpose, so there are artificial shortages and doctors get paid the highest possible wages....around $250K to start, and much more at mid-career.
I'll bet not one doctor in Mexico makes anything close to this.
So...here is the catch: how do we get US doctors to work for $25-$75K a year? how do we educate so many US doctors, that we have a SURPLUS and they must COMPETE for patients?
NOTE: any change in their luxe, luxe lifestyles and any threat to their incomes, and doctors will strike and fight like enraged rapid weasels.
1
As a single Mom with 2 children living/working in Germany for over 8 years I got to experience their healthcare system firsthand and it is EXCELLENT! Children's healthcare is FREE and adult care is a mere fraction of the cost compared to the US. You can choose to go to any doctor. Every weekend the local papers let you know which doctor and pharmacy near you is available if you get sick so there is no need to go to a hospital Emergency Room unless it is absolutely necessary. Family members visiting us experienced medical needs such as a broken arm and leg, dental emergencies, etc. They were all treated immediately, given crutches/slings, Rx's and root canals as part of their treatment and amazed to find that it cost near to nothing. Having experienced the German healthcare system, it was very difficult for me to consider returning to the US. Here my monthly medical insurance premium, just for major medical and Rx, is more than what I paid there for housing costs per month. My son remained in Germany to work and we are considering moving back as retirees in order to reduce our medical costs. A private medical insurance plan there is cheaper than what we pay in the US and it includes EVERYTHING, major medical, Rx's, optical, dental, etc. Germany's medical system is superior to ours in many ways and at a fraction of the cost that we pay! All Americans would benefit if we implemented Germany's healthcare system here!!
10
Not true about the cost of private medical insurance. I pay 800 per month just for myself although it does include everything (comparable to US 800 dollars). And they won't cover you if you are older and have existing conditions and are applying for the first time. Even if younger and applying for the first time, you pay more if you have existing conditions.
2
It's true about existing conditions, but that's large dental, after 3 years you don't pay more. If you can put off major dental with patch jobs until then, you pay as much as normal people.
A monthly medical care premium of $800 that covers EVERYTHING is CHEAP when compared to what I currently pay for just myself. My monthly premium is $943.24 and it only covers major medical and prescriptions. AND did I mention the additional cost of meeting my yearly deductibles, co-pays, and remaining 20-30% coinsurance costs for services? My husbands Medicare costs although cheaper than mine still does not include complete medical coverage like full dental/optical making Germany’s costs for private insurance still a better offer for a reasonable price.
2
Compare cost of CT Scan
- at French public hospital : $100 (of which 70% is reimbursed by national health system, remainder paid for by patient and/or supplemental policy)
- at Johns Hopkins hospital: $7,000.
- at French public hospital : $100 (of which 70% is reimbursed by national health system, remainder paid for by patient and/or supplemental policy)
- at Johns Hopkins hospital: $7,000.
12
pc: but nobody actually pays $7000. That is the "rack rate" -- the chargemaster price. It is fake, so that the hospital and insurance company do a sort of little dance until they get to a price they agree on.
What is the true cost, anyways? the $1500 or so it costs in the US? or the $100 that you pay in France? remember that the French cost is not authentic; it is heavily subsidized by tax dollars. Someone has to pay those taxes, to get the subsidy!
We can't really discuss this rationally until we determine the TRUE cost of that CT scan...how much government pays in France...what portion is taxpayer paid....how much the US insurance company REALLY pays....and so on.
BTW: in the US, if you do not have insurance, you can often negotiate a "cash price" that is much less than the posted price.
What is the true cost, anyways? the $1500 or so it costs in the US? or the $100 that you pay in France? remember that the French cost is not authentic; it is heavily subsidized by tax dollars. Someone has to pay those taxes, to get the subsidy!
We can't really discuss this rationally until we determine the TRUE cost of that CT scan...how much government pays in France...what portion is taxpayer paid....how much the US insurance company REALLY pays....and so on.
BTW: in the US, if you do not have insurance, you can often negotiate a "cash price" that is much less than the posted price.
1
I am quite happy for my taxes to pay for health care. I need not fear that ill health will upset my retirement plans, or that I will ever have to go into debt to pay for the best treatment available.
In France, we have no deductibles, no waiting, no rationing, no exclusion of pre-existing conditions. Meds, vision, dental - and catastrophic - are all included, much as in US Medicare plans. Supplemental plans do exist (highly regulated) to cover fees that may exceed the government-negotiated amounts for each category of expense.
Medical decisions are the sole responsibility of the doctor with the patient: there are no "faceless bureaucrats" and no all-powerful insurance companies to veto the treatment selected.
I am free to choose my GP and my specialists, to pick my hospital or clinic (public or private).
It is a 99% paperless system.
In France, we have no deductibles, no waiting, no rationing, no exclusion of pre-existing conditions. Meds, vision, dental - and catastrophic - are all included, much as in US Medicare plans. Supplemental plans do exist (highly regulated) to cover fees that may exceed the government-negotiated amounts for each category of expense.
Medical decisions are the sole responsibility of the doctor with the patient: there are no "faceless bureaucrats" and no all-powerful insurance companies to veto the treatment selected.
I am free to choose my GP and my specialists, to pick my hospital or clinic (public or private).
It is a 99% paperless system.
Without a way to measure each of these systems this analysis is purely subjective. The measure needs to be on the value delivered to the patient based on results.
Every one of these systems has distortions often due to regulations, that result in incentives not matching rewards. In the US' fee based model for example the incentive is to treat - not cure; the NHS' the incentive is to stay within budget - not cure; in both there is no incentive for the individual to stay healthy. There are many many more of these distortions resulting in the US system being a zero sum game for all participants - patients, providers, payers.
The trick is fixing the US system will be for the government to mandate real competitive measures, regulate trust and privacy, support the poor financially, and remove regulations that distort incentives, and let it become a normal competitive business. Innovation will be driven by an incentive to lower costs to be competitive, IT will be mandatory and improve through innovation. Information transparency and mandatory reporting of standard measures will allow individuals to shop for care that delivers the most cost effective results for their medical condition. Paying for care with your own money will incentivize people to look after themselves.
Utopia? dream on.
Every one of these systems has distortions often due to regulations, that result in incentives not matching rewards. In the US' fee based model for example the incentive is to treat - not cure; the NHS' the incentive is to stay within budget - not cure; in both there is no incentive for the individual to stay healthy. There are many many more of these distortions resulting in the US system being a zero sum game for all participants - patients, providers, payers.
The trick is fixing the US system will be for the government to mandate real competitive measures, regulate trust and privacy, support the poor financially, and remove regulations that distort incentives, and let it become a normal competitive business. Innovation will be driven by an incentive to lower costs to be competitive, IT will be mandatory and improve through innovation. Information transparency and mandatory reporting of standard measures will allow individuals to shop for care that delivers the most cost effective results for their medical condition. Paying for care with your own money will incentivize people to look after themselves.
Utopia? dream on.
1
" Paying for care with your own money will incentivize people to look after themselves."
Oh. Yup. People will REALLY shop around while they're bleeding to death, or, let's not be flippant, when they have to travel A LOT to get to their cancer threat ments. "incentivized Shopping around" therefor ASSUMES huge price 'differences, which there aren't a lot of within countries. Now, say it with me, people: "Assume makes an A... out of U and ME"
But sure, there are distortions.
And sure, treatment based on results (Mayo?) rather than services (USA, Switz) is better.
Oh. Yup. People will REALLY shop around while they're bleeding to death, or, let's not be flippant, when they have to travel A LOT to get to their cancer threat ments. "incentivized Shopping around" therefor ASSUMES huge price 'differences, which there aren't a lot of within countries. Now, say it with me, people: "Assume makes an A... out of U and ME"
But sure, there are distortions.
And sure, treatment based on results (Mayo?) rather than services (USA, Switz) is better.
Our costs are completely out of control. There is no incentive to lower costs, and no incentive to compare outcomes versus costs. It is very hard to shop for healthcare.
Try this in your local area, get costs and complication rates for two common treatments: Vaginal birth & a broken arm on an adult male. Both procedures with no complicating factors.
Try this in your local area, get costs and complication rates for two common treatments: Vaginal birth & a broken arm on an adult male. Both procedures with no complicating factors.
3
Two things are important to me: 1) the ability to choose my preferred doctor, whether surgeon or specialist; and 2) The waiting time to see a specialist who can diagnose and treat my problem. I lived in London for more than three years in the 2000s; the NHS was a failure on both counts unless you had supplemental private insurance. I was limited to a choice of two GP clinics by the Post Code (Zip Code in US terminology) where I lived. Fortunately one clinic was quite good and competent. The waiting time for the cataract surgery I desperately needed was most of nine months counting the time to see an ophthalmologist to get diagnosed (three months) and an eye surgeon for the removal of the clouded lens and insertion of a prosthetic (six months more).
So I went private. Fortunately, to maintain my eligibility for certain Medicare coverage when I returned to the USA, I had kept a very expensive American private policy which paid in the U.K. That let me choose a British surgeon; my American eye doctor had already diagnosed the cataract. By great good fortune, friends in London steered me to a surgeon who was world renowned for his skill and innovations.
An American ophthalmologist actually recognized his work!
I do not want an NHS-like system unless it allows a parallel private yst
So I went private. Fortunately, to maintain my eligibility for certain Medicare coverage when I returned to the USA, I had kept a very expensive American private policy which paid in the U.K. That let me choose a British surgeon; my American eye doctor had already diagnosed the cataract. By great good fortune, friends in London steered me to a surgeon who was world renowned for his skill and innovations.
An American ophthalmologist actually recognized his work!
I do not want an NHS-like system unless it allows a parallel private yst
1
Can you please explain what eligibility requirements were? I would like to get medicare benefits when I return to the US to retire. Thanks.
I think this is a "very American" take on the NHS - you were a visitor yet covered by the NHS? Imagine! I'm not a medical pro, but a cataract is neither rapid-onset (AFAIK) nor life-threatening. If not then by definition this was a special case. Otherwise an obvious treatment to "ration". And are not millions of cataracts removed annually? Was yours special? Or is it just that underlying belief in Americans that their own personal health needs outweigh everyone else's?
2
sylvia: the eligibility for Medicare is being a US citizen, and over 65 years of age. That's all.
1
I lived in Canada until 9 years ago. In 2008, I paid $83 (Canadian dollars; about $70 U.S. dollars) a month for my province's health care plan. I could choose my own doctor, and doctor's visits, surgery, and hospitalization were all covered, with no deductible, no copay, no payment of any kind. In the last few years I lived in Canada, I had two surgeries, both were urgent, both required hospitalization, and I had no wait -- and NO EXTRA COST! All covered for just $83 a month in Canadian dollars. Waiting times are only for elective procedures, and the waits are not that long. The Canadians have given themselves a dream system that is popular with nearly all Canadians. Compare the Canadian system to the American for-profit system that leaves millions with no insurance and unable to pay what can be astronomical charges -- it seems hard to justify the cruel system here.
9
I am concerned about the degree of "regulation" which our doctors will tolerate...as well as manipulation of the number of people allowed to attend medical school. As well, the cost of medical education depends on docs being well paid.. (I am not a doc.)
1
it's always interesting reading stories about american health care compared to other countries. there are, invariably, many american ex pats who've experienced health care in their current country of residence. the comments seem wildly positive in their new homes compared to the usa. too many americans seem to fall for the BS in the so called debates comparing the american system to others. crazily inaccurate nonsense about other countries. however, ask the people in the other countries if they'd trade with the american system--if it can be called that--and i'm pretty sure the usa would score pretty miserably.
7
Medicare is the 52-year-old US health insurance program for older people and the disabled. It establishes a menu of covered medical treatments at certain prices, and then pays doctors and hospitals whenever a beneficiary uses them.
But for the US population as a whole the health care system is a shambles, with access to affordable health insurance being the bugger factor.
In his single-payer health care bill, Senator Bernie Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill is very different from the current Medicare program, envisaging changing Medicare in two important ways.
First, it would make it more generous, expanding it to cover new types of benefits and to erasing most direct health care costs for consumers. Those changes would tend to make it more expensive. They would also make the health care system more affordable, but the details could have big effects on what sorts of care might be developed and made available.
Gone will be incentives for investment in health care innovation which, IMO, is a Good Thing. Too many doctors these days make their money by enhancing the living, in opposition to their Hyppocratic Oath to cure the sick.
But for the US population as a whole the health care system is a shambles, with access to affordable health insurance being the bugger factor.
In his single-payer health care bill, Senator Bernie Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill is very different from the current Medicare program, envisaging changing Medicare in two important ways.
First, it would make it more generous, expanding it to cover new types of benefits and to erasing most direct health care costs for consumers. Those changes would tend to make it more expensive. They would also make the health care system more affordable, but the details could have big effects on what sorts of care might be developed and made available.
Gone will be incentives for investment in health care innovation which, IMO, is a Good Thing. Too many doctors these days make their money by enhancing the living, in opposition to their Hyppocratic Oath to cure the sick.
"Some judges took a global view, giving the edge to countries, like the United States, that promoted innovation that benefited the rest of the world. "
But over time the experimental procedures have drifted over to Europe as the US insurers no longer fund these treatments and the FDA is a barrier to trials.
Fecal Matter Transplant is a good example. These are common in Australia, the UK, Bahamas and more but practically banned in the US as The FDA has decided human poop is an experimental drug. Ther is only one US exception; C.Diff and the patient needs to have had three rounds of monster antibiotics before that is approved.
But over time the experimental procedures have drifted over to Europe as the US insurers no longer fund these treatments and the FDA is a barrier to trials.
Fecal Matter Transplant is a good example. These are common in Australia, the UK, Bahamas and more but practically banned in the US as The FDA has decided human poop is an experimental drug. Ther is only one US exception; C.Diff and the patient needs to have had three rounds of monster antibiotics before that is approved.
I would be relieved to receive all my health care under the Canadian system. When I lived in Canada my family experienced birth, heart failure, heart attacks, & basic care. Nothing in the US in 30 years has come close to surpassing the care my family received but then I am a regular person not a wealthy one. My Canadian friends routinely receive better care than my American ones- including cancer, chronic diseases, routine care. Recently while visiting friends in Toronto, I had an emergency appendectomy & the experience remained every bit as positive as earlier ones. Meanwhile, I see many of my American family & friends paying outrageous sums for healthcare if they are the lucky ones who they can afford it. The ones who can't struggle & hope they can live to Medicare age since the US system exists by breaking the backs of people who cannot afford decent healthcare. The US system sucks. HEALTHCARE IS A HUMAN RIGHT.
5
Thsnks. NYT, for the conversation. Looking forward to the paper endorsing Single Payer in some form or other!
3
The cost of drugs and devices must be controlled. Permit drug purchases globally and permit device purchases globally
The costs of service providers ( physicians, various nurses, therapists, etc). must be controlled----NO FEE FOR SERVICE. Everybody salaried.
USA develop adequate universal broadband (particularly rural) to permit in home evaluation and treatment of patients
The costs of service providers ( physicians, various nurses, therapists, etc). must be controlled----NO FEE FOR SERVICE. Everybody salaried.
USA develop adequate universal broadband (particularly rural) to permit in home evaluation and treatment of patients
2
Some of the most important parts of the Swiss system were not mentioned:
1. The government writes a basic policy which all companies must offer at no profit.
2. The government keeps tabs on physicians & if they have flaws in their practice, they receive a dreaded "blue letter."
3. Switzerland has the second highest cost per person, much higher than the UK and France.
Here are the per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3 - 8
Switzerland - 7 919.0 - 4
Germany - 5 550.6 - 5
Australia - 4 708.1 - 2
France - 4 600.4 - 7
Canada - 4 643.7 - 6
UK - 4 192.5 - 1
Singapore - 4047 (WHO 2015)
The last number are the actual rankings in the Commonwealth Find study referred to in the article. Singapore was not rated. It should be noted that some of the ratings were close & some were far apart. For example, the US was way below France. You can see the graph at http://www.newsweek.com/united-states-health-care-rated-worst-637114
http://www.who.int/healthinfo/paper30.pdf giver the WHO rankings & an explanation of how they were ranked. I don't know the date. They rank them:
France - 0.994
Singapore - 0.973
UK - 0.925
Switzerland - 0.916
Germany - 0.902
Canada - 0.881
Australia - 0.876
US - 0.838
The lowest ranked country is El Savador - 0.608
I have never seen any data that show that the US contribution medical innovation is anything more than one would expect from its size and wealth.
1. The government writes a basic policy which all companies must offer at no profit.
2. The government keeps tabs on physicians & if they have flaws in their practice, they receive a dreaded "blue letter."
3. Switzerland has the second highest cost per person, much higher than the UK and France.
Here are the per capita figures for health care costs in 2016 in PPP dollars (which take cost of living into consideration) from the OECD:
US - 9 892.3 - 8
Switzerland - 7 919.0 - 4
Germany - 5 550.6 - 5
Australia - 4 708.1 - 2
France - 4 600.4 - 7
Canada - 4 643.7 - 6
UK - 4 192.5 - 1
Singapore - 4047 (WHO 2015)
The last number are the actual rankings in the Commonwealth Find study referred to in the article. Singapore was not rated. It should be noted that some of the ratings were close & some were far apart. For example, the US was way below France. You can see the graph at http://www.newsweek.com/united-states-health-care-rated-worst-637114
http://www.who.int/healthinfo/paper30.pdf giver the WHO rankings & an explanation of how they were ranked. I don't know the date. They rank them:
France - 0.994
Singapore - 0.973
UK - 0.925
Switzerland - 0.916
Germany - 0.902
Canada - 0.881
Australia - 0.876
US - 0.838
The lowest ranked country is El Savador - 0.608
I have never seen any data that show that the US contribution medical innovation is anything more than one would expect from its size and wealth.
9
from my experience, innovation is better in many european countries. less lobbying to keep outdated procedures, or drugs in place.
1
Most of the comparative discussions in the article did not address the most serious consequence of the US system: the fact that medical bankruptcy is a real possibility for all but the wealthiest Americans. We have very expensive care, and even with "good" workplace insurance, it is possible for the patient's portion to be very high. With weak or no coverage, it doesn't take much care before bills mount to beyond what ordinary people can pay.
One comparison rated the US system higher because of the quality of care; what is the quality of "no care because you can't afford it"?
One comparison rated the US system higher because of the quality of care; what is the quality of "no care because you can't afford it"?
9
I agree that this is the major difference between the US and the other countries in the comparison. No where else, in the developed world, can any person risk going bankrupt due to medical treatment.
I live in Denmark, where we have universal taxpayer financed health care. Treatment is free at the point of delivery, while prescription drugs are heavily subsidized. There is a treatment guarantee of four weeks for non emergency treatments, and one week for cancer and serious heart disease. The only fly in the ointment is, that it doesn't cover dentaI.
I believe that universal health care is a basic human right.
I live in Denmark, where we have universal taxpayer financed health care. Treatment is free at the point of delivery, while prescription drugs are heavily subsidized. There is a treatment guarantee of four weeks for non emergency treatments, and one week for cancer and serious heart disease. The only fly in the ointment is, that it doesn't cover dentaI.
I believe that universal health care is a basic human right.
4
I noticed one thing which may skew things more than one would think. The first choice of the two received the most votes in every pairing.
1
I was a bit surprised by the US vs. Singapore result. Several years ago, I slipped on a wet stairway in Singapore and broke my ankle. I needed to be admitted to hospital to have the ankle reset with a steel reinforcement plate installed permanently. Upon return to the US, my doctors confirmed that the repairs were done exactly as my US doctors would have treated the problem-----but when I received the estimates of what the exact same treatment would have cost in the US, it was more than 5x greater than the entire cost of hospitalization, operation, and follow up care in Singapore. My business travel has taken me to many other countries over the past 35 years, and my care has always been at least as good as the US medical care I receive, and has consistently cost far less in every foreign country where I needed healthcare.
22
We have a similar story. My wife broke her jaw cycling in Cape Town. The entire ordeal cost us GBP4500 (all paid by our UK travel insurance before the credit card bill was due - 100%)- that included a clinic visit, a 2nd hospital, then a specialist maxillo-facial surgeon consult, CT scan, 3.5 hrs surgery (and all associated with that) two days in the hospital, jaw wiring, plate inserted, etc.
Upon return to London the consultant praised the SA surgeon's work. No subsequent issues (no numbness or nerve damage). Imagine what that would have cost in the USA...
Upon return to London the consultant praised the SA surgeon's work. No subsequent issues (no numbness or nerve damage). Imagine what that would have cost in the USA...
1
I picked France over Switzerland because of population & diversity. France has more people with various problems to deal with, and Swiss is more homogeneous with fewer problems. If they are equally good, then I would pick the more experienced one. I also like France because of her socialistic society where physicians & specialists do not take profit as their priority in patient treatment. This provides saving for the medical industry. In contrast, US healthcare companies & professionals have more profit in mind when dealing with patients.
5
I am an aged pensioner, living in Australia. I have completely free doctor and hospital visits, including x rays. Pathology etc. My dental care is also free, as is optical care. I have a heart condition requiring medication, one of which is vary expensive,but all my prescribed medications are covered by a subsidy which means I pay only $6.30 and all prescriptions are free once I reach a yearly ceiling. People who are working have a medicare levy as part of their tax levy. That covers basic health care, and then they are expected to have private health insurance for subsidiaries like dental, optical etc. Those who can pay something for their health care are expected to, but people like me are very well looked after.
22
as a Canadian almost the same,except we still have to have insurance or pay for dental,working on changing that...isn't it nice to lie in a civilized country
3
Your coverage is Not free. It remains a kind of insurance scheme paid for you and every other Australia resident through national taxes plus any private insurance you chose, if anybody.
1
Agreed - it is not free. It is, however, a much fairer, more efficient and less-expensive system.
1
In 1972, in Berlin, our four-year old daughter came down with pneumonia. We took her to a hospital that had an almost medieval appearance, inside and out. They took our daughter to a private room, put her in an oxygen tent, and kept her for 4 days. She recovered quickly, and we were never charged a cent.
4
I particularly enjoyed this simulation. I am a senior in high school currently taking the AP Government and Politics course. The first few weeks of the year is spent discussing economics (GDP, opportunity cost, etc.). We spent some time on health care when we were discussing the political differences of North Korea and Sweden. While they both have health care provided by the government, the quality is obviously very different.
With the rising tension on the United States' health care system today, it is interesting to read about how and who America could model a new health care system on. Paying the highest percentage of the GDP out of these countries, American's health care while innovative is not as efficient as it can be. While Switzerland was a great choice for a winner, I felt France's health care system portrays the best of all worlds.
With the rising tension on the United States' health care system today, it is interesting to read about how and who America could model a new health care system on. Paying the highest percentage of the GDP out of these countries, American's health care while innovative is not as efficient as it can be. While Switzerland was a great choice for a winner, I felt France's health care system portrays the best of all worlds.
7
We lived in Cambridge, England, for a year, 1978-78. My wife developed a pinched nerve by a cervical vertebra. The NHS diagnosed her, but said frankly that the wait for treat,ent would be long, so we ,might want to consider a private hospital. That hospital confirmed diagnosis and gave her treatment suggestions. She returned to NHS to follow up, and they sent a physical therapist to our house, several times per week, for 2 months. My wife recovered, and were very satisfied. Very little cost to us.
In 2010, we returned to Cambridge for a short visit. My wife was stung in her foot a hornet. She went to NHS for treatment, which was convenient and prompt. We were charged $50 fee for non-Brits. Once again, very satisfied.
In 2010, we returned to Cambridge for a short visit. My wife was stung in her foot a hornet. She went to NHS for treatment, which was convenient and prompt. We were charged $50 fee for non-Brits. Once again, very satisfied.
5
I wish I could get a physical therapist to come to my house under my health insurance plan which is considered a Cadillac plan. It costs a fortune for the premiums.
6
Brilliant comparisons. Lived in UK in '60's and National Health was pretty dreary then - as was Britain. . .
1
I don't think there can be anything worse than the American health care "system." No amount of "innovation" can make up for the anxiety -- often verging on terror -- that American citizens regularly experience at the hands of our for-profit health insurance ghouls and their Congressional enablers.
We were finally leaving the Dickensian world of denial for pre-existing conditions, lifetime caps on coverage, and sheer unaffordability with the advent of the ACA, but even those few concessions to mercy are too much for the Republicans. They will forever, like zombies, rise up to float yet another bill to kill Obamacare. How many people today are going into medical bankruptcy even with insurance? Too bad; maybe you can live on some "free market solutions."
I am utterly against any system that includes for-profit health insurance or tying insurance to employment. When will Americans understand that insurance companies add nothing --ZERO-- to the delivery of actual health care to human beings. All these corporations do is sit between the patient and the provider and siphon off an obscene amount of money that could otherwise be used to provide care. Let them insure cars, houses and property and get out of the business of making money on the backs of the sick and dying.
We were finally leaving the Dickensian world of denial for pre-existing conditions, lifetime caps on coverage, and sheer unaffordability with the advent of the ACA, but even those few concessions to mercy are too much for the Republicans. They will forever, like zombies, rise up to float yet another bill to kill Obamacare. How many people today are going into medical bankruptcy even with insurance? Too bad; maybe you can live on some "free market solutions."
I am utterly against any system that includes for-profit health insurance or tying insurance to employment. When will Americans understand that insurance companies add nothing --ZERO-- to the delivery of actual health care to human beings. All these corporations do is sit between the patient and the provider and siphon off an obscene amount of money that could otherwise be used to provide care. Let them insure cars, houses and property and get out of the business of making money on the backs of the sick and dying.
14
Europe versus US? I'll tell you a few experiences from my side and then you decide:
- My father and I went skying in Sierra Nevada, Spain. He had an accident, we went to the hospital, where he stayed for 2 nights and was brought home on a ambulance (home is Portugal, a different country). Cost? Zero )paid by the Portuguese government)
- My father had testicular cancer - 2 surgeries, chemotherapy and needs to run regular exams and scans for the rest of his life. Cost? Zero, and has a 60% tax break because he is sick
- I had a son born premature while on holidays on the countryside of Portugal. My wife and my son spent 10 days at the hospital. Bill? Zero
Part of our taxes go to the healthcare system. It costs 8.9% of GDP. Portugal is ranked 12th by WHO (25 spots ahead of the US), our infant mortality rate is half of the US and life expectancy is higher. And if you are poor, in Portugal 50% of the population does not pay taxes because they are considered poor, you pay almost nothing for your health. Yes, one might wait a few months for non urgency procedures but do you really want to compare?
- My father and I went skying in Sierra Nevada, Spain. He had an accident, we went to the hospital, where he stayed for 2 nights and was brought home on a ambulance (home is Portugal, a different country). Cost? Zero )paid by the Portuguese government)
- My father had testicular cancer - 2 surgeries, chemotherapy and needs to run regular exams and scans for the rest of his life. Cost? Zero, and has a 60% tax break because he is sick
- I had a son born premature while on holidays on the countryside of Portugal. My wife and my son spent 10 days at the hospital. Bill? Zero
Part of our taxes go to the healthcare system. It costs 8.9% of GDP. Portugal is ranked 12th by WHO (25 spots ahead of the US), our infant mortality rate is half of the US and life expectancy is higher. And if you are poor, in Portugal 50% of the population does not pay taxes because they are considered poor, you pay almost nothing for your health. Yes, one might wait a few months for non urgency procedures but do you really want to compare?
14
I wonder the assessments of comparisons would have been different if the panellists were from different countries or with different social or financial status. Also, the assessments should have been focused on a set of common goals rather than left to the choosing of the panellists.
No matter how good a system is, if people cannot afford it, then it's a bit pointless. Good health is a right and the degree of your health should not depend on your degree of wealth, especially if it is denied because of cost.
No matter how good a system is, if people cannot afford it, then it's a bit pointless. Good health is a right and the degree of your health should not depend on your degree of wealth, especially if it is denied because of cost.
4
Isn't it interesting that for many Americans living, studying or even just holidaying in some of the European countries mentioned , the care they receive usually costs them next to nothing or is much, much cheaper than they would have to pay in America. Not only that but the areas covered, service and outcome is usually as good or superior to that found in the U.S.
What does it say to Americans that being a citizen means they will pay much more, receive much less and have more problems in their Homeland in regards to Healthcare.
Yet as foreigners not even contributing to these systems, they receive better, more compassionate and virtually free Health care.
What does that tell you?
What does it say to Americans that being a citizen means they will pay much more, receive much less and have more problems in their Homeland in regards to Healthcare.
Yet as foreigners not even contributing to these systems, they receive better, more compassionate and virtually free Health care.
What does that tell you?
14
I was with these judges until I got to the 3-2 France/US decision. No one in their right mind would pick the US over what France has (universal coverage for a fraction of the cost). 9 to 1, voters agreed.
25
I used to live in Switzerland, and although I didn't have to use the healthcare system much, the main point is clear: All the details you discuss in the various matchups are important and need to be considered, but the one overriding thing that matters to patients is access and lack of hassle. If you can go to the doctor when you need to, and do so without having to waste huge amounts of time (beforehand on endless choices of policy; afterwards on endless calls to the insurance company to get them to pay), you will be much, much happier. It is that simple. On that score, ANY of these countries would be better than the US (Switzerland certainly is).
9
I love the images!
As far as American innovation is concerned, I question the results. Does the world need yet another NSAID? Statin? A lot of the drive is making that billion dollar drug. Some of the orthopedic advances are useful, and surgical advances in general are amazing. A great deal of the advancements come from university research, which we pay for with our taxes.
From my personal experience, the only two non-USA health care systems I'm familiar with are Sierra Leone during the ebola epidemic and Dominican Republic. Yup, the USA system was better than both of those, but that isn't saying much.
As far as American innovation is concerned, I question the results. Does the world need yet another NSAID? Statin? A lot of the drive is making that billion dollar drug. Some of the orthopedic advances are useful, and surgical advances in general are amazing. A great deal of the advancements come from university research, which we pay for with our taxes.
From my personal experience, the only two non-USA health care systems I'm familiar with are Sierra Leone during the ebola epidemic and Dominican Republic. Yup, the USA system was better than both of those, but that isn't saying much.
1
Statins were discovered by 3 Japanese academics.
5
There is an excellent book comparing systems around the world. It is "The Healing of America" by T. R Reid. Slightly dated (10 years) but still highly relevant. This article left out Japan. He points out that aspects of the U.S. system exist in the other world systems, but they do a better job of it.
The Bismarck Model (named for Otto Von Bismarck who invented it in 1800's). Its a private insurance model that is used in Germany, Japan, France and Switzerland, among others.
The Beveridge Model relies on the State government to supply and pay for health care, such as the VA in the U.S. These include Cuba, Great Britain, and Italy.
And the Canadian Model. A Medicare for all model.
But no matter how you slice it, no matter what trips your trigger, all the rest of the world outperforms us in terms of breadth of coverage, quality of outcomes, and basic cost. We are the equivalent of 3rd and 4th world countries where your access to a good job or wealth determines what health care you can get and bunches of people are left on their own. It is a moral outrage. And, IMO, what drives our lousy outcomes is the necessity of the health insurance companies to make big profits. Take away the profit motive and we can fix all this.
The Bismarck Model (named for Otto Von Bismarck who invented it in 1800's). Its a private insurance model that is used in Germany, Japan, France and Switzerland, among others.
The Beveridge Model relies on the State government to supply and pay for health care, such as the VA in the U.S. These include Cuba, Great Britain, and Italy.
And the Canadian Model. A Medicare for all model.
But no matter how you slice it, no matter what trips your trigger, all the rest of the world outperforms us in terms of breadth of coverage, quality of outcomes, and basic cost. We are the equivalent of 3rd and 4th world countries where your access to a good job or wealth determines what health care you can get and bunches of people are left on their own. It is a moral outrage. And, IMO, what drives our lousy outcomes is the necessity of the health insurance companies to make big profits. Take away the profit motive and we can fix all this.
16
The experts cited in this article acts like new innovations in healthcare and poor people dying of preventable diseases are two sides of the same coin, easily compared. They're not. As glad as I would be to see new innovations coming from the U.S. if I had a rare disease, the fact of the matter is that far more people die here of things we can already treat, especially if we catch them early with good preventive care: heart disease, common cancers like breast or prostate, diabetes respiratory diseases, stroke.
Any system in which thousands of the poor die of preventable or treatable disease for lack of funds, while extending pricey new treatments for rarer diseases to the world's rich, is not a system I consider worth salvaging. Just more trickle-down economics, only for whether or not you'll live.
Any system in which thousands of the poor die of preventable or treatable disease for lack of funds, while extending pricey new treatments for rarer diseases to the world's rich, is not a system I consider worth salvaging. Just more trickle-down economics, only for whether or not you'll live.
5
I lived in Belgium for the last nine years and just moved back to the US with my wife and two boys. Sure, we paid a lot more in taxes but health insurance (mandatory) was about 1200 euros/year. For that, we received amazing care. We could call our doctor and get an appointment either that day, or the next. No admins, nurses, bureaucracy - just a friendly 1-1 conversation with someone who made you feel like he had all the time in the world for you. This was with any doctor we'd see. Care at this level extended to psychologists, specialists, therapists, dentists. I also never got the feeling anybody ever tried to upsell me on anything, or provide additional care that I didn't need. Doctor's visits cost 25 EUR, which was called "break money" meaning, it was only there to put the breaks on so that you didn't see your doctor for all of your minor ailments. One example of the efficiencies of the system: I was hospitalized for one week with pneumonia about 2 years ago. I paid 125 EUR for the entire week. When I got the "official" bill (that insurance took care of) the total of that bill was around 1200 EUR. For a week. On top of that, I received full pay from my job and completely covered. No worries, no stress.
7
I am unclear on why you describe the Canadian system as 'the private sector delivers care'. What private sector? All hospitals in Canada, with very few exceptions (such as Shriners hospitals), are run by the respective government health departments. Although physicians in private practice and in a lot of hospitals are essentially independent contractors, they only bill the provincial health department for patient care. It is true that dentistry and optometry are not covered, and prescription drugs in most but not all provinces, but the bulk of care provided by physicians is through the government programs.
4
As a fellow Canadian, I had the same question.
1
A question for the Canadians.
I often read about comparisons of the US and Canada regarding healthcare. The conclusions of those articles usually highlight the point that Canada is much more equitable, but there are onerous waiting times.
Here is my question-- do you think that the geographical reality of Canada has an effect on these statistics? For example, in terms of population density, Canada as a whole is like Alaska. A huge land mass with very large sparsely populated areas. Alaska is dead last among American states in terms of "access to healthcare."
In your experience, are the waiting times less of an issue in the more densely populated provinces? Might the "waiting time issue" have less to do with "single payer" vs. "free market" and more to do with the reality of delivering care equitably over such a vast area?
I often read about comparisons of the US and Canada regarding healthcare. The conclusions of those articles usually highlight the point that Canada is much more equitable, but there are onerous waiting times.
Here is my question-- do you think that the geographical reality of Canada has an effect on these statistics? For example, in terms of population density, Canada as a whole is like Alaska. A huge land mass with very large sparsely populated areas. Alaska is dead last among American states in terms of "access to healthcare."
In your experience, are the waiting times less of an issue in the more densely populated provinces? Might the "waiting time issue" have less to do with "single payer" vs. "free market" and more to do with the reality of delivering care equitably over such a vast area?
each province has its own system. the vast majority of canadians live within about a three hour drive from the american border. the waiting times are for elective surgery. i live in ontario and nobody i know who was seriously ill or had a serious injury had to wait. i'm sure there must be some examples, but not that i know of.
my father died in 2006. he paid the price of more than 60 years of smoking and probably 50 years of alcoholism. he was almost 79.
he started spitting up blood tho not an enormous amount and not continually. saw a specialist within a few days. had tests with the results in a few days. he was in the hospital within a week.
he was there for almost five weeks. got first rate care.
we paid for a tv&phone. we cancelled both when he got too sick to use them. biggest expense was parking.
in my case, i was almost deaf in my left ear. went to my family doctor. he set me up with a specialist. i saw him in two weeks. he said i needed a stapedectomy. i had to wait 11 months because they prioritize. i didn't love the wait, but i wasn't in pain and could hear perfectly with my right ear.
i was in the hospital for about 5 1/2 hours with two of them under a general anesthetic. cost was parking
all i have to do was show my health card. i never see a bill.
finally, i lived in japan off and on for 19 years. i would've had the operation within a few days there, but would've been a week in the hospital and pay 20% of the cost. dental and drug plan are included.
my father died in 2006. he paid the price of more than 60 years of smoking and probably 50 years of alcoholism. he was almost 79.
he started spitting up blood tho not an enormous amount and not continually. saw a specialist within a few days. had tests with the results in a few days. he was in the hospital within a week.
he was there for almost five weeks. got first rate care.
we paid for a tv&phone. we cancelled both when he got too sick to use them. biggest expense was parking.
in my case, i was almost deaf in my left ear. went to my family doctor. he set me up with a specialist. i saw him in two weeks. he said i needed a stapedectomy. i had to wait 11 months because they prioritize. i didn't love the wait, but i wasn't in pain and could hear perfectly with my right ear.
i was in the hospital for about 5 1/2 hours with two of them under a general anesthetic. cost was parking
all i have to do was show my health card. i never see a bill.
finally, i lived in japan off and on for 19 years. i would've had the operation within a few days there, but would've been a week in the hospital and pay 20% of the cost. dental and drug plan are included.
1
I have found the Dutch system exemplary. My family receive great benefits - nursing assistance during the first week a baby is home, regular child care, a top notch array of specialists. Personally, I have very much appreciated the greater simplicity of routine office visits - less technology, lower costs.
2
The moral difference between the U.S. approach, and that of the other countries where there is private insurance participation is it is illegal for investors to profit off primary care.
United Health Network made a profit of $2.5 billion last year. They are also under investigation for ginning their Medicare reporting, which allegedly netted them substantial ill-gotten gains. Greed has no place in health care financing. There is no reason that investors should take a piece of a multi-trillion dollar endeavor for which no investment is needed, as capitalization and entry-requirements are low, and especially when it should be serving all our citizens.
United Health Network made a profit of $2.5 billion last year. They are also under investigation for ginning their Medicare reporting, which allegedly netted them substantial ill-gotten gains. Greed has no place in health care financing. There is no reason that investors should take a piece of a multi-trillion dollar endeavor for which no investment is needed, as capitalization and entry-requirements are low, and especially when it should be serving all our citizens.
16
I'm a dual national. I'm currently in the US for a regular 6 week visit. Went to a public hospital this morning for a routine blood draw. 20 minutes drive. Covered by Medicare in the US. Typical US scenario - 4 people doing paperwork in the lab for insurance, and 1 person drawing blood. Total time spent at lab - 1 hour! Results will be available at my next Dr. visit, but I will need to ask for a copy of the results. Hopefully, in the US system, my Dr. coded the lab order correctly and the lab personnel entered the data correctly, otherwise Medicare Part B will refuse to pay and the lab will demand me to pay.
Had a blood draw in France last month. 1 person to enter blood draw order into computer and use my Carte Vitale to bill my local French Social Security office for the service. No medical coding needed from my Dr. is needed for billing. Social Security pays appx. 70% of the bill. Social Security transmits claim data to my secondary private insurer who pays the co-pay directly to the lab. Lab is privately owned at 5 minute walk from my abode. 3 people available to draw blood. Total wait time - 5 minutes. Lab results available online same day. The USA could do much better.
Had a blood draw in France last month. 1 person to enter blood draw order into computer and use my Carte Vitale to bill my local French Social Security office for the service. No medical coding needed from my Dr. is needed for billing. Social Security pays appx. 70% of the bill. Social Security transmits claim data to my secondary private insurer who pays the co-pay directly to the lab. Lab is privately owned at 5 minute walk from my abode. 3 people available to draw blood. Total wait time - 5 minutes. Lab results available online same day. The USA could do much better.
19
Two points - 1) There is an inaccuracy in the description of Canadian health care, where it is described as not including dental, prescriptions, and vision. These things are covered to some degree in many provinces. They're often fully covered for children and seniors. For example, in British Columbia (where I live), there is a maximum annual cost for prescriptions after which they are fully paid by the government depending on income - from fully covered for people with low incomes to $6000 for people in the top income tier. People in the lowest income bracket get $1000/yr toward dental, and also vision exams, and some coverage toward glasses. 2) What I think wasn't emphasized enough by the experts is how wonderful it is to have a simple health system, where you have a medical card and don't have to think about insurance, what doctor you can go to, etc. Although there are ways the Canadian health system could be improved, overall it's great.
11
thank god every day i live in Canada
This article ignores the fact that the reason US health care expenses are so high is because of our extremely high levels of chronic disease - diabetes, obesity, and heart disease. it also fails to mention that doctors in France are paid very little - but France as a country has a great food culture, people walk everywhere, does not have our levels of obesity, and French women have some of the longest life expectancies on the planet.
2
Studies have shown that the number of medical procedures per capita is very similar in the US and France.
The big driver of costs is that each medical procedure costs three times as much in the US as it does in France.
The big driver of costs is that each medical procedure costs three times as much in the US as it does in France.
12
Laura: the high obesity rates are NOT in the US; we are ranked #4 in the world. Australia and New Zealand actually have MORE obesity per population -- yet still have universal health care.
No -- the problem is diversity and poverty. The US alone of all these nations has a very high rate of poverty and a HUGE underclass of poor minorities. Without these, you can compare white middle class Americans with white middle class Brits, Aussies, NZs, Swiss, Canadians or anyone -- we do as well or better.
NONE of these other nations could cope with a 30% population underclass of poor, uneducated, illiterate patients who have atrocious habits: smoke, eat junk food, use illegal drugs....have staggering obesity and diabetes rates...and even with FREE Medicaid, don't follow doctors orders...don't do correct diabetic or high BP care....don't use contraception....for example, poor mothers on Medicaid skip all their prenatal care, then present at the hospital in labor, expected Medicaid to pay 100% of bills (on the taxpayer) -- mother is morbidly obese, with high bp (untreated), gestation diabetes (untreated), NO pre natal care or vitamins, no ultrasounds or amnio -- she smokes, drinks, takes illegal drugs -- shows up HIGH at deliver -- then everyone is gobsmacked when she has a poor result, and baby dies or mother has severe complications. Mind you -- this is WITH 100% FREE Medicaid welfare!
There is nothing comparable in these other nations -- NOTHING.
No -- the problem is diversity and poverty. The US alone of all these nations has a very high rate of poverty and a HUGE underclass of poor minorities. Without these, you can compare white middle class Americans with white middle class Brits, Aussies, NZs, Swiss, Canadians or anyone -- we do as well or better.
NONE of these other nations could cope with a 30% population underclass of poor, uneducated, illiterate patients who have atrocious habits: smoke, eat junk food, use illegal drugs....have staggering obesity and diabetes rates...and even with FREE Medicaid, don't follow doctors orders...don't do correct diabetic or high BP care....don't use contraception....for example, poor mothers on Medicaid skip all their prenatal care, then present at the hospital in labor, expected Medicaid to pay 100% of bills (on the taxpayer) -- mother is morbidly obese, with high bp (untreated), gestation diabetes (untreated), NO pre natal care or vitamins, no ultrasounds or amnio -- she smokes, drinks, takes illegal drugs -- shows up HIGH at deliver -- then everyone is gobsmacked when she has a poor result, and baby dies or mother has severe complications. Mind you -- this is WITH 100% FREE Medicaid welfare!
There is nothing comparable in these other nations -- NOTHING.
1
Italy was not included. We lived there for 15 years and were delighted with our healthcare. It is free to citizens, and very low-cost to non-citizens. While I do not know the mechanics of how it is organized, I can say that our care was excellent, especially if the situation was acute. Yes, we had to wait for certain tests if it was not an emergency, but that was certainly acceptable. I'm sure the system is not as organized as that in Switzerland or Germany (nothing in Italy is as organized as it is in its northern neighbors) and I suspect outcomes are not as good. Nonetheless we received excellent care for both acute and non-acute health concerns.
3
The article states "In Canada, the government finances health insurance, and the private sector delivers care." If the authors define "private sector" as the provincial governments of Canada then it would be correct. The federal government of Canada provides funds for health care to each province. Each provincial government delivers healthcare how it choses to, not the "private sector." I'm confused by their portrayal of the Canadian system.
8
Sorry - limiting yourself to US analysts leaves a lot to be desired, as to local understanding and usage. I was very disappointed that you did not obtain balance by local analysis.
The Australian system is based on utilising our overall taxes for universal health care - that is not dependent on employer-sponsored eligibility. We all pay our taxes, even when well, knowing that others should receive the health care they need. Not - what they can only afford to pay for.
Consequently, we have a reasonably uniform health system across a widely-dispersed country and its population. That's a communitarian health system we all value. Not the ridiculous designation of 'socialism" so frequently and ignorantly attached to it.
I am surprised that anyone would prefer any aspects of the US system, which consumes vast amounts of money for not much different outcomes. The US spent 17.1% of its GDP on health care in 2014 and Australia's was 9.4%. That meant there was a lot of public and private money available for expenditure outside the health system, in Australia. The UK's was a similar 9.1%.
In 2010, my wife's life was saved by the Australian health system, when she needed a bone marrow transplant for her leukemia, after chemotherapy had failed. We experienced expert (free) care by specialists in two public hospitals, with some ancillary costs paid by my wife's private health insurance.
The Australian system is based on utilising our overall taxes for universal health care - that is not dependent on employer-sponsored eligibility. We all pay our taxes, even when well, knowing that others should receive the health care they need. Not - what they can only afford to pay for.
Consequently, we have a reasonably uniform health system across a widely-dispersed country and its population. That's a communitarian health system we all value. Not the ridiculous designation of 'socialism" so frequently and ignorantly attached to it.
I am surprised that anyone would prefer any aspects of the US system, which consumes vast amounts of money for not much different outcomes. The US spent 17.1% of its GDP on health care in 2014 and Australia's was 9.4%. That meant there was a lot of public and private money available for expenditure outside the health system, in Australia. The UK's was a similar 9.1%.
In 2010, my wife's life was saved by the Australian health system, when she needed a bone marrow transplant for her leukemia, after chemotherapy had failed. We experienced expert (free) care by specialists in two public hospitals, with some ancillary costs paid by my wife's private health insurance.
9
The salaries of Australian doctors are lower than doctors in the US, and in the case of most specialists, much lower. There are a tiny number of doctors in private practice who earn huge salaries, but the medians are low: orthopedic surgeon, US $175K, cardiac surgeon, US $125K. GPs average $100K, compared to $185K in the US.
1
It would be worth finding out whether Australian doctors have to go into large amounts of student debt to finance their degrees. I suspect not. The only justification for the high salaries for doctors in the US is their obscenely high debt load ($160k on average in 2016 upon graduation); otherwise, they could go ahead and have reasonable salaries that didn't bleed our system. Student debt is a driver of health care costs, however partial, and one that is never discussed.
1
Most of the highest-paid doctors are in their 40s and 50s, and paid off their debt long ago. It is not really that hard to pay it off if you make $200-400K a year.
1
We've lived in Germany, Switzerland, and The Netherlands and found things we liked and disliked about each system. We liked the German system which gives you the option of private or nationalized insurance. The doctors there still make housecalls.
I think it would be more insightful to ask expats of countries what they experience using these healthcare systems, when their life or the life of a family member was on the line, vs. a panel of people of have no experience of depending on healthcare in another country. This is what I find missing in all the comparisons out there. Look at all the great comments here by expats as an example - they're far more qualified to comment.
Perhaps that is an idea for a follow up article - create a panel of actual users and see what they come up with.
I think it would be more insightful to ask expats of countries what they experience using these healthcare systems, when their life or the life of a family member was on the line, vs. a panel of people of have no experience of depending on healthcare in another country. This is what I find missing in all the comparisons out there. Look at all the great comments here by expats as an example - they're far more qualified to comment.
Perhaps that is an idea for a follow up article - create a panel of actual users and see what they come up with.
8
Very neat article. I have lived in Canada, Australia and Switzerland, so I have experience with all of those systems in addition to the American system. I was happy to see Switzerland "win" -- I had surgery there and recuperated in a private room for 12 CHF -- about $20. I also had positive experiences in Australia and Canada. By far, the US system is my least favorite.
18
While Britain clearly offer more it does not have the same relationship with the USA. Canada's proximity and its status as an economic satellite severely limits Canada's ability to offer a better system. Healthcare is mandated to the provinces precisely because of what happened to Canada's publicly owned oil company. Canada was forced to privatize its highly successful oil company because Exxon and its company owned governments demanded it.
Even though my wife and I have US Medicare we still choose our Quebec services even with our closest hospital being in Vermont.
Vermont offers us a well run modern hospital and excellent doctors and nurses but there is much to be said for zero paperwork and no hassles especially as we grow older.
Even though my wife and I have US Medicare we still choose our Quebec services even with our closest hospital being in Vermont.
Vermont offers us a well run modern hospital and excellent doctors and nurses but there is much to be said for zero paperwork and no hassles especially as we grow older.
9
It's too bad that the Times neglected to add the health care system in Taiwan, which would have won this competition hands-down, in my opinion. (Not surprisingly, Taiwan, a democracy, is often excluded from attention because of the world kowtowing to China.)
As an expat in Taiwan for more than 30 years, I have had numerous opportunities to encounter its health care system. I am enrolled in National Health Care, which costs me about $75 (USD) a month. For that, I can go into any clinic, of which there are an incredible number, see a doctor AND receive medication as necessary---for an additional $3-$4. If I elect to see a doctor in a hospital setting, I need to make an appointment and the cost per visit goes up--to about $15. Tests are done promptly and with near-immediate feedback. I had more than one visit where the doctor I was seeing arranged for an x-ray or other test, sent me down to the lab, and then reported the results to me back in his office within 90 minutes. One example I can provide that gives an idea about more dramatic costs is the premature (by nearly two months) of my twins. They were in the hospital for a full month gaining weight and receiving excellent care. My total out-of-pocket for the doctors, hospital fees, and all related costs was about $4000.
Doctors that I have encountered here are well-trained, knowledgeable, and have access to some of the best equipment available. Health care is one reason why expats have rated Taiwan the #1 place to live.
As an expat in Taiwan for more than 30 years, I have had numerous opportunities to encounter its health care system. I am enrolled in National Health Care, which costs me about $75 (USD) a month. For that, I can go into any clinic, of which there are an incredible number, see a doctor AND receive medication as necessary---for an additional $3-$4. If I elect to see a doctor in a hospital setting, I need to make an appointment and the cost per visit goes up--to about $15. Tests are done promptly and with near-immediate feedback. I had more than one visit where the doctor I was seeing arranged for an x-ray or other test, sent me down to the lab, and then reported the results to me back in his office within 90 minutes. One example I can provide that gives an idea about more dramatic costs is the premature (by nearly two months) of my twins. They were in the hospital for a full month gaining weight and receiving excellent care. My total out-of-pocket for the doctors, hospital fees, and all related costs was about $4000.
Doctors that I have encountered here are well-trained, knowledgeable, and have access to some of the best equipment available. Health care is one reason why expats have rated Taiwan the #1 place to live.
4
This was an interesting exercise. The inherent problems with the the US system are many. However, these stand out for me.
First, innovation is great but US consumers shoulder the burden of the costs for that innovation. The world benefits but most of the world also has controls on costs for innovations used within their health systems. Other than Medicare the US currently has no government controls on costs to consumers. This leads to hospitals, doctors and phrmaceutical companies relying on the US market to recoup costs. Surely this is not an equitable way to do things.
Second, in the US insurance companies, pharmaceutical companies and the hospital industry control our healthcare system through their lobbying efforts. We will never be able to bring down costs and provide true universal health insurance with those groups controlling Congress and literally writing laws. The system is broken because Congress allowed it to break through the corrupt activites that contine to go on in Washington.
Finally, many Americans in red and blue states have been brainwashed into thinking that universal healthcare is tantamount to Socialism. They fear a government take over of their well being. This is delusional thinking. Medicare and Social Security are social programs that (almost) no American wants to lose. A big mistake the Obama administration made was not properly educating Americans about what ACA does for them. That problem also has to be solved before a universal system can pass.
First, innovation is great but US consumers shoulder the burden of the costs for that innovation. The world benefits but most of the world also has controls on costs for innovations used within their health systems. Other than Medicare the US currently has no government controls on costs to consumers. This leads to hospitals, doctors and phrmaceutical companies relying on the US market to recoup costs. Surely this is not an equitable way to do things.
Second, in the US insurance companies, pharmaceutical companies and the hospital industry control our healthcare system through their lobbying efforts. We will never be able to bring down costs and provide true universal health insurance with those groups controlling Congress and literally writing laws. The system is broken because Congress allowed it to break through the corrupt activites that contine to go on in Washington.
Finally, many Americans in red and blue states have been brainwashed into thinking that universal healthcare is tantamount to Socialism. They fear a government take over of their well being. This is delusional thinking. Medicare and Social Security are social programs that (almost) no American wants to lose. A big mistake the Obama administration made was not properly educating Americans about what ACA does for them. That problem also has to be solved before a universal system can pass.
12
Population density should be considered.Delivering good healthcare to remote communities in Australia & Canada is difficult & expensive.Not surprising that Switzerland & Germany win, no excuse for Singapore.
4
I lived in France for 13 years and have worked in medical care in all of the countries in the list. I would choose the French model. One important aspect of the French system is their method of choosing who gets into medical school. Any graduate can apply for medical training. After their basic training, they can apply for any specific field of training. The number of slots open in any field, such as psychiatry, anesthesiology, surgery, family practice, etc., depends on the projected need. Since medical school is free, there is no need for doctors or nurses to pay off student debt. Thus, there is no need for charging patients or insurance companies as much as possible. Since prices are based on procedure and are fixed, there is no need for long delays while insurance companies and health care providers dicker over the amount paid. The French system is well appreciated by patients and care givers in any opinion polls.
25
Thank you for sharing the information about French medical school tuition. In the U.S. we all are hurt by medical student debt since it forces med students to go into specialties where they can earn enough money to repay debt. We are also denied the services of gifted students who cannot afford to take on medical school debt.
We have a shortage of general practitioners as a result. General practitioners can cost less to see, can spend more time listening to you, and are more likely to be in a position to teach self care and wellness. They are valuable to rural communities where they are sorely needed.
Specialty clinics are more likely to be profit driven, putting the interests of the clinic or specialty group over those of the the patient.
The New Zealand system is very good in some ways and lacking in others. My own experience is mixed but overall very satisfied. As far as access to a doctor is concerned, you can pick anyone. When you call for an appointment they are apologetic if you can't get in that day unless you are willing to see another doctor in the practice. The quality of care is excellent.
My emergency room experience was eye-opening. I had an arrhythmia, walked in, barely had time to give them my name when I was hustled off to a room. I was in the hospital for three nights, even though I was in a normal rhythm within a few hours, and had no physical issues. I never filled out a form, I never saw a piece of paper, I never got a bill for anything.
Prescription drugs vary. Most are "covered" - you pay a $5 copay, but after a certain number of refills, the copay goes away. Other drugs come with a cost but nothing like US retail.
Where the public system falls down is for lack of resources. There aren't enough specialists - New Zealand doctors often leave for other places after medical school. We're pretty remote, after all. And government doesn't fund the system well enough to retain and recruit an adequate number of doctors. That's not a reason to not have a public system. It's far better than the US system. Life expectancy here is *two years* longer than in the US, after all.
Re the British NHS, I recommend reading this:
https://www.ft.com/content/4c866ec0-777a-11e7-90c0-90a9d1bc9691
My emergency room experience was eye-opening. I had an arrhythmia, walked in, barely had time to give them my name when I was hustled off to a room. I was in the hospital for three nights, even though I was in a normal rhythm within a few hours, and had no physical issues. I never filled out a form, I never saw a piece of paper, I never got a bill for anything.
Prescription drugs vary. Most are "covered" - you pay a $5 copay, but after a certain number of refills, the copay goes away. Other drugs come with a cost but nothing like US retail.
Where the public system falls down is for lack of resources. There aren't enough specialists - New Zealand doctors often leave for other places after medical school. We're pretty remote, after all. And government doesn't fund the system well enough to retain and recruit an adequate number of doctors. That's not a reason to not have a public system. It's far better than the US system. Life expectancy here is *two years* longer than in the US, after all.
Re the British NHS, I recommend reading this:
https://www.ft.com/content/4c866ec0-777a-11e7-90c0-90a9d1bc9691
10
It's hard to take seriously a panel of experts, some of whom place value on a innovative American system that penalizes Americans by charging them more than any other country pays for that same innovation while leaving tens of millions without any real healthcare coverage. I don't see how that qualifies as an expert opinion.
44
So the US wins on innovation. Unless that innovation is monetized and used to subsidize health care of Americans, it hardly counts. It may benefit the world, but Americans still have a lower life expectancy and worse health than much of the developed world.
24
Your interesting tournament led me to two thoughts:
1. I would like to have heard about the relative economic inequalities the different countries need to serve. I wonder if there is less poverty overall in Switzerland and that perhaps is a major factor in their system's success.
2. I wonder if the fact that the U.S. is such a late bloomer in the universal health care is a major reason that the system is so expensive. Doctors and hospitals have been "setting" the prices for so long, it will be too painful for them to take the price/pay controls these other countries set decades ago.
1. I would like to have heard about the relative economic inequalities the different countries need to serve. I wonder if there is less poverty overall in Switzerland and that perhaps is a major factor in their system's success.
2. I wonder if the fact that the U.S. is such a late bloomer in the universal health care is a major reason that the system is so expensive. Doctors and hospitals have been "setting" the prices for so long, it will be too painful for them to take the price/pay controls these other countries set decades ago.
6
There is less poverty overall in Switzerland because they believe in paying their people better at the low end, and less well at the high end (for the most part, but not completely). There is no minimum wage and people are required to pay to have at least basal medical care, which I'm told is very good. The Swiss also have a direct democracy where decisions are voted on directly. From my experiences in the cities, there is also very little homelessness. So the extremes are removed and the citzenry gets to make decisions collectively.
2
Susan: Switzerland is also a tiny, all white, homogenous, non diverse nation of only 5 million people.
It is simply unfair to compare it to the ENTIRE US of 330 million, VERY diverse and non-homogenous. In population, in size, in diversity, we absolutely dwarf Switzerland.
It would make more sense to compare Switzerland to (say) just one US city or region -- like "just Manhattan and Brooklyn". If you did so, you'd probably see very different results of the comparison, as you'd have just affluent white people to compare.
It is simply unfair to compare it to the ENTIRE US of 330 million, VERY diverse and non-homogenous. In population, in size, in diversity, we absolutely dwarf Switzerland.
It would make more sense to compare Switzerland to (say) just one US city or region -- like "just Manhattan and Brooklyn". If you did so, you'd probably see very different results of the comparison, as you'd have just affluent white people to compare.
1
You should not have to suffer mental anguish worrying whether a serious illness will drive you to the poorhouse. That's the bottom line for me.
I have experienced a number of healthcare systems. In Poland, where I live now, the public healthcare system is woefully underfunded when it comes to paying for innovations. The inevitable rationing of services also leads to long lines in clinics and long delays for many treatments, but at the end of the day, the system does a pretty good job of taking care of most people's health needs, and private sector primary HMOs are very inexpensive and quite good.
Germany probably does the best job of delivering high-level technology to the greatest number of its citizens, with Switzerland right on up there.
The UK NHS gets beat up all the time, but it delivers pretty good service and has come up with some ingenious ways of assessing the worth of innovations.
The US has the means to do a pretty good job of delivering basic universal healthcare with supplemental insurance for those who want more services or more rapid access. And I am sorry to say that the US health insurance industry is the real villain of the piece.
I have experienced a number of healthcare systems. In Poland, where I live now, the public healthcare system is woefully underfunded when it comes to paying for innovations. The inevitable rationing of services also leads to long lines in clinics and long delays for many treatments, but at the end of the day, the system does a pretty good job of taking care of most people's health needs, and private sector primary HMOs are very inexpensive and quite good.
Germany probably does the best job of delivering high-level technology to the greatest number of its citizens, with Switzerland right on up there.
The UK NHS gets beat up all the time, but it delivers pretty good service and has come up with some ingenious ways of assessing the worth of innovations.
The US has the means to do a pretty good job of delivering basic universal healthcare with supplemental insurance for those who want more services or more rapid access. And I am sorry to say that the US health insurance industry is the real villain of the piece.
22
I have lived in, and thus have experienced both the US and Canadian systems. My choice is Canada, although some thought needs to be given to wait times, as well as including drugs (in British Columbia). The US is far too costly and simply doesn't cover everyone. Example: In the US I ran across a female barber with kids - and no coverage. If one kid got seriously ill she could be indebt for the rest of her life. That's un-American in my view.
22
Who compares systems like this? Include a table comparing ALL health systems, with columns for each property - public and private cost, health outcomes, access, breadth of coverage, etc.
4
Read the report they cite but don't really use in the article to get that information you need and mentioned, it's all here:
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
The big lesson from this article is that with the passage of Obamacare, we have the foundations of a health care system that has already proven its excellence in Switzerland. by following that model, with more stringent individual mandates that force everyone into the health care system and a more muscular government role as a negotiator and price setter, the U.S. can have universal access to quality medical care, a healthier population, and cut costs by 30% or so.
7
I grew up in England using the NHS, and although I have had good employee medical insurance, and now Medicare, i would still prefer it. For one thing, I find it distressing that so many of my fellow-citizens (I am a naturalized US citizen) consider health care a privilege and not a right.
I keep hearing that in other countries you have to wait to see doctors. Well, you have to wait in the US, too. I live in an area with plenty of hospitals (including two major university medical centers) and doctors, but a referral to a rheumatologist involved a four month wait, and getting to see an infectious diseases doctor has proved almost impossible.
I had experience of Swiss medical care when I broke my wrist. I was the only patient in the emergency room, I was seen immediately and I got excellent care. The bill (covered by my employee insurance) for X-rays, surgery to insert pins, an overnight stay (six bed ward) and associated doctors' bills was the same as the bill for the brief out-patent surgery in the US to remove the pins.
In Italy I have had a doctor visit me at no charge, and I have paid a French doctor 30 euro for a visit. The French doctor had no receptionist, no nurse and certainly no back-office staff processing paperwork. The overhead for our unwieldy insurance is staggering.
I have one on-going prescription which costs me $300. I checked the price in the UK. Even with a private prescription it would be $15.
I keep hearing that in other countries you have to wait to see doctors. Well, you have to wait in the US, too. I live in an area with plenty of hospitals (including two major university medical centers) and doctors, but a referral to a rheumatologist involved a four month wait, and getting to see an infectious diseases doctor has proved almost impossible.
I had experience of Swiss medical care when I broke my wrist. I was the only patient in the emergency room, I was seen immediately and I got excellent care. The bill (covered by my employee insurance) for X-rays, surgery to insert pins, an overnight stay (six bed ward) and associated doctors' bills was the same as the bill for the brief out-patent surgery in the US to remove the pins.
In Italy I have had a doctor visit me at no charge, and I have paid a French doctor 30 euro for a visit. The French doctor had no receptionist, no nurse and certainly no back-office staff processing paperwork. The overhead for our unwieldy insurance is staggering.
I have one on-going prescription which costs me $300. I checked the price in the UK. Even with a private prescription it would be $15.
26
Americans' accounts of their illness experiences abroad are helpful for the contrast with the US, even if anecdotal. Your series might be balanced by accounts from developed country travelers who fall ill in the US. My guess is that, like the US, most countries do not cover their citizens while traveling abroad. But then, what happens? How do they cope with the financial disaster that their bill will bring? I'm sure there are many stories out there.
2
There are many stories.
As foreigners who are visiting the U.S for a trip /holiday we are ALL strongly advised to take travel Insurance for ANY trip to the U.S due to the huge costs involved.
When comparing different travel insurance policies available Every single one charges MUCH HIGHER premiums for travel to the U.S versus any other region or country in the World.
I have heard some real horror stories of hapless tourists being decimated by treatment needed and undertaken in the U.S
As foreigners who are visiting the U.S for a trip /holiday we are ALL strongly advised to take travel Insurance for ANY trip to the U.S due to the huge costs involved.
When comparing different travel insurance policies available Every single one charges MUCH HIGHER premiums for travel to the U.S versus any other region or country in the World.
I have heard some real horror stories of hapless tourists being decimated by treatment needed and undertaken in the U.S
12
Travel insurance is recommended for those visiting the US.
1
In the days before everything was booked online, travel agents used to have big warnings about being sure to buy travel insurance if going to the USA. I remember one brochure with terrifying tales of people who had been injured and how it destroyed them financially.
I am so often surprised by the biased coverage, even with NYT, for non-anglo-saxon/white man countries. The details of Singapore's system is inaccurate. For example, the percentage for employee's contribution is 20% not 37%. The difference of 17% comes from the employer. Second, the judges seems to miss the point that this 20% is *not* (emphasize again *not*) solely for healthcare. Its primary purpose is for retirement. Healthcare, and especially the other purposes that it can be used, such as its crucial role in owning a property (clearly not well appreciated by the judges), is not the main purpose.
Third, my daughter happens to work in analytics for one of the government hospital chain. To say that there are not enough data available would be sacrilege! Furthermore, since when is data opacity a crucial factor in this comparison even if it is true? Is this just another symptom of obsession with worship of extremist democracy ideology?
Finally, there are numerous subsidy schemes for various groups of citizens. Examples include one for early pioneers who helped establish the nation (practically free), another for early detection of common problems such as diabetes (costing less than US$4 per checkup, beat that!)
I take Singapore's system any time, hands down. The US system is literally dreadful if you are in the underclass.
Third, my daughter happens to work in analytics for one of the government hospital chain. To say that there are not enough data available would be sacrilege! Furthermore, since when is data opacity a crucial factor in this comparison even if it is true? Is this just another symptom of obsession with worship of extremist democracy ideology?
Finally, there are numerous subsidy schemes for various groups of citizens. Examples include one for early pioneers who helped establish the nation (practically free), another for early detection of common problems such as diabetes (costing less than US$4 per checkup, beat that!)
I take Singapore's system any time, hands down. The US system is literally dreadful if you are in the underclass.
14
Singapore's Health Care System is ranked 6th in the World. Say no more!
2
Call me crazy, but it seems like some healthcare experts and journalists are intentionally erasing any mention of price controls in healthcare systems around the world. This is a huge disservice. The lack of price regulation in our system is the overwhelming factor behind our out-of-control healthcare costs. Failing to mention that Switzerland has price regulation, and instead lazily asserting that the Swiss system resembles the ACA exchanges, is arguably journalistic malpractice.
27
One reason why the medical system works in Germany is because higher education is free. That means doctors do not have to charge or earn such high rates as in the US just to make ends meet. If a 'single-pay' system had a chance of working in the US without being way too expensive, the cost of education would have to be subsidized by the government, i.e. taxpayers. I would not mind paying more for the betterment of our our entire population - which would then include myself. Can't understand why so many sneer and belittle this attitude as 'socialism'.
11
I'm ok with subsidizing both med school and liability insurance for doctors if we have a single-payer system.
6
It isn't just the cost of medical school; doctors in the US have a mental expectation that part of BEING a doctor is being rich.
Though the cost of medical school is high, most doctors can easily pay it off within about 5-10 years -- some much sooner -- the average borrowed is about $250,000 and the average doctor makes about $300,000.
I live near two teaching hospitals and have many neighbors who are interns or residents there. I have asked countless such folks, over the years: "if your medical school bills were 90% paid by government....and if you were guaranteed to work no more than 55 hours per week....would YOU then agree to work for the rest of your professional life (DEBT FREE!) at a modest, middle class income"?
To a man (and woman)...THEY ALL SAID NO. They didn't study and work hard and go to medical school to earn $80K a year (as German doctors do!).
The whole POINT of med school in the US is to become a "rich doctor". Our mentality is that doctors are RICH. And they are!
I am all for single payer/universal care. Now: tell me how you will sell Americans on a 300% tax increase...PLUS a VAT on every single purchase! and then how you will convince every doctor, nurse and administrator to take a 50% pay cut!
When you do that, we can have single payer.
Though the cost of medical school is high, most doctors can easily pay it off within about 5-10 years -- some much sooner -- the average borrowed is about $250,000 and the average doctor makes about $300,000.
I live near two teaching hospitals and have many neighbors who are interns or residents there. I have asked countless such folks, over the years: "if your medical school bills were 90% paid by government....and if you were guaranteed to work no more than 55 hours per week....would YOU then agree to work for the rest of your professional life (DEBT FREE!) at a modest, middle class income"?
To a man (and woman)...THEY ALL SAID NO. They didn't study and work hard and go to medical school to earn $80K a year (as German doctors do!).
The whole POINT of med school in the US is to become a "rich doctor". Our mentality is that doctors are RICH. And they are!
I am all for single payer/universal care. Now: tell me how you will sell Americans on a 300% tax increase...PLUS a VAT on every single purchase! and then how you will convince every doctor, nurse and administrator to take a 50% pay cut!
When you do that, we can have single payer.
1
Honestly? Any one of them is so much better, so much more secure, so much more cost-effective and has so much better health outcomes than those available to all but the fabulously wealthy in the United States that it's preposterous.
8
But the wealthiest country in the history of the world not only can't afford universal healthcare coverage (according to republicans and trump), republicans want to provide less, more expensive coverage so that they can give more tax cuts to the wealthy. Lets go back to taxing income over $500,000 at 50%,dividends @25%,raise the social security ceiling to $500,000 and let Americans be secure that they have good healthcare and strong social security. Back when we taxed large incomes at 90%,people still innovated, still began new businesses and those at the top income levels continued to strive to make more money. Republicans never let the facts get in the way of their failed economic "trickle down" theory.
6
This really is the issue, isn't it. Not about whether health care is of high quality, not people living longer, more productive lives (the pursuit of happiness), not management efficiency. No, it's ideology plain and simple and a health care program does not fit into that ideology, along with a lot of other things like consumer protection, environmental quality, education for the masses, any regulation of business, restrictions on arms manufacturers, civil rights, etc etc. The ideology is about concentration of power. Free, unfettered markets are a means to that end.
1
The issues here are greater than attributing problems in the malfunctioning expensive health care system to insurance companies who treat their customers like cash cows.
The problem with health care in the US is that the US is the only country in the civilized world that still uses the insurance company based system for health care which is REGRESSIVE to the insured. In contrast, Canada, Japan and Western Europe use the single-payer health care system which is PROGRESSIVE to the insured.
Notwithstanding the positive developments of more affordable health care being offered to Americans under the ACA, the central issue on explaining the high costs for health care that has NOT been debated is that the U.S. insurance system of health coverage is REGRESSIVE. It is regressive in that a given policy with identified benefits will have a set price and this price is to be paid by all persons whether they are rich or poor. As a result, the rich buy the Cadillac versions and the poor the Skateboard versions.
In contrast the public single payer system of payments through taxes is PROGRESSIVE. In Canada, the government established that everyone has the right to have free access to health care. But the fact is that all health care expenses are paid by taxes and these payments of income taxes are progressive in that the more one makes in income the more one pays in taxes.
The universal health care system in Canada is not perfect, but it works. Also administration costs are much lower.
The problem with health care in the US is that the US is the only country in the civilized world that still uses the insurance company based system for health care which is REGRESSIVE to the insured. In contrast, Canada, Japan and Western Europe use the single-payer health care system which is PROGRESSIVE to the insured.
Notwithstanding the positive developments of more affordable health care being offered to Americans under the ACA, the central issue on explaining the high costs for health care that has NOT been debated is that the U.S. insurance system of health coverage is REGRESSIVE. It is regressive in that a given policy with identified benefits will have a set price and this price is to be paid by all persons whether they are rich or poor. As a result, the rich buy the Cadillac versions and the poor the Skateboard versions.
In contrast the public single payer system of payments through taxes is PROGRESSIVE. In Canada, the government established that everyone has the right to have free access to health care. But the fact is that all health care expenses are paid by taxes and these payments of income taxes are progressive in that the more one makes in income the more one pays in taxes.
The universal health care system in Canada is not perfect, but it works. Also administration costs are much lower.
7
It would be helpful in future iterations of this discussion to include some measure of individual tax burden for each of these countries. Most Americans are willing to listen to other health systems' organization, but they'll always ask: "Yeah, but what are individuals in those countries paying in taxes?"
4
"... and what do they get in return?"
("... the price of everything and the value of nothing." Americans in a nutshell.)
("... the price of everything and the value of nothing." Americans in a nutshell.)
I was an American expat living in London. I spent one Saturday night with an abscessing tooth getting progressively more painful. Finally, at about 3:00 Sunday morning I called the NHS. The extremely helpful rep directed me to a clinic in Soho available immediately, with the option to see a dentist near my flat in Kensington later in the morning. When I asked "how much will this cost?" there was a pause, and then she replied, "Nothing. We're a civilized country." The care was exemplary, the people were all friendly and helpful, and instead of spending all the time with paperwork we face here in the U.S., I was in and out quickly and don't recall getting anything in the mail afterwards.
29
We do not choose to become ill. For the most part it is an unfortunate disgrace.
Healthcare in the United States, as everything else is business, a sorry and criminal business that takes advantage of .... that human disgrace.
How come that a nation with 800 military bases and a military budget that exceeds the 7 following countries TOGETHER can't provide medical care as Canada or the UK do?
For starts, eliminating the middle man leech insurance companies and instituting a national insurance card guranteeing one stop care will save billions. After that, price control of drugs which also will be delivered, both covered by a reasonable and apropriate tax.
Society can't continue being hostage to a bunch of docs and bureaucrats whose greed aims at buying a second Mercedes for each one of their kids.
ENOUGH ALREADY!!!!
RESIST!!!
Change!!!
Healthcare in the United States, as everything else is business, a sorry and criminal business that takes advantage of .... that human disgrace.
How come that a nation with 800 military bases and a military budget that exceeds the 7 following countries TOGETHER can't provide medical care as Canada or the UK do?
For starts, eliminating the middle man leech insurance companies and instituting a national insurance card guranteeing one stop care will save billions. After that, price control of drugs which also will be delivered, both covered by a reasonable and apropriate tax.
Society can't continue being hostage to a bunch of docs and bureaucrats whose greed aims at buying a second Mercedes for each one of their kids.
ENOUGH ALREADY!!!!
RESIST!!!
Change!!!
14
it would've been better to include japan if the nyt was only going to choose one asian country. singapore only has a handful, relatively speak of people. japan is a full fledged democracy with about 127,000,000 people.
7
You dropped 3 countries starting with "N" from the report (Mirror, Mirror 2017) that you based this on which have even more small quirks that may be worthy of attention. For example, NZ has no concept of "government health insurance" - rather your name and date of birth is enough to get treated in the public system (using National Health ID - NHI number). It has two tier health care with private health insurance for most treatments and non Pharmac drugs. The cost of medicines is kept very low (and this is a rare thing for many countries) by using Pharmac - a national drug buying agency with large buying power over the Pharmaceutical Industry which has spreadsheets of "$$$ per extra year of life" to decide what can fit into its budget. Note that one of the demands from US int he TPP from NZ was to disestablish Pharmac - which is why NZ'ers hated TPP till this clause was dropped by the US.
2
I think "no concept of government health insurance" is a bit misleading to the uninitiated. While the government (central government) may not be a direct provider of health care, the District Health Boards have a great deal of influence over the quality of care and its availability. The fact that these tend to do a pretty good job (nobody is perfect) is a testament to the relative lack of political pollution in every day life here. Not so in the US, where politics permeates and poisons absolutely everything.
2
Well, reading this and knowing enough about your health care to be sure that it is abominable, certainly for the poor and the wretched, I think it is a shame that the opinion of some tends to think that your system is worth anything at all. It only serves the rich. When I was helped in a hospital in Moab for a dental inflammation and I was prescribed antibiotics, the doctor was very arrogant when I and my wife tried to be friendly and somewhat informal (my wife is a doctor too), the hospital gave me some medication but made a mistake in the calculation of the bill, called me the next morning about this at the campsite, when I came to the hospital I discovered that there was another mistake with the recipe, and finally the bill was about $800!! $800 for a arrogant doctor and some antibiotics.... He had to come to the hospital for me, but for the rest it was simple. In The Netherlands all of this would have cost nothing or very little. When we were home from our beautiful trip the hospital send us an extra bill; we never understood what was the meaning of that bill. We tried to contact the hospital but we never got any response. I don't think this is exemplary for the total of the US health care, but even so. It is unbelievable that this happens in the richest (ha) country in the world. Rich in money but so poor in empathy and care. A country that calls itself Christian. Shame on you!
14
And it gets a lot worse than that.
3
We lived in UK, Italy, Switzerland, Canada, and USA for extensive periods of time over several years.
We found the American system: excellent for those who have economic independence; absolutely unacceptable for a large portion of the population (25M without coverage and, at least, 10M under-Insured. Before the so called Obama care, the uninsured were 45M!?!)
Like our private dental coverage in Canada, we are never sure if the hospitals and the doctors in US are treating our cases or based on our health insurance. One year, while visiting the Yellowstone National Park, my wife had a flareup of diverticulitis. The clinic in the Park sent us to the Hospital in Jacksonhole. As soon as they found out that we had a good insurance coverage, she was shipped for a CAT scan before I had finished giving all the information at the admission desk... I spare you what the treating doctor wanted us to do in his private clinic, after being discharged from the hospital.
Regarding the waiting time in Canada, we are working on this issue. First of all, there are no delays for critical interventions. My wife will be operated next week for double knee replacement within two months from first seeing the surgeon. Not bad for a "socialist" (?!?) system. Diego Nigro, Toronto, Canada
We found the American system: excellent for those who have economic independence; absolutely unacceptable for a large portion of the population (25M without coverage and, at least, 10M under-Insured. Before the so called Obama care, the uninsured were 45M!?!)
Like our private dental coverage in Canada, we are never sure if the hospitals and the doctors in US are treating our cases or based on our health insurance. One year, while visiting the Yellowstone National Park, my wife had a flareup of diverticulitis. The clinic in the Park sent us to the Hospital in Jacksonhole. As soon as they found out that we had a good insurance coverage, she was shipped for a CAT scan before I had finished giving all the information at the admission desk... I spare you what the treating doctor wanted us to do in his private clinic, after being discharged from the hospital.
Regarding the waiting time in Canada, we are working on this issue. First of all, there are no delays for critical interventions. My wife will be operated next week for double knee replacement within two months from first seeing the surgeon. Not bad for a "socialist" (?!?) system. Diego Nigro, Toronto, Canada
14
Anyone of the them would be a substantial improvement to the pathetic health care system of the United States. My wife being French, she is most partial to the French system. She also spent some time living and working in Montreal decades ago, but she thought even Canada's system far superior to ours. Considering that Canada has one-tenth the populace of the US, less than 30 million live in Canada, and can afford to provide better care for its citizens while a nation as large in population as the United States cannot is an obscenity. The reason the United States has such a terrible system for the average American is because an apathetic and clueless populace has allowed it.
Voters who keep putting Republicans in office, who believe in limited government intervention, which translates to NO Federal help whatsoever, and convey their philosophy to the voters, yet have the voters ignore what Republicans say and ignorantly re-elect them are the real culprits in this malaise. If Republicans in any of the other countries mentioned were to tell the people this, they wouldn't be elected dog catcher. Only in a poorly educated country such as the United States could Republicans who deny Climate Change, Evolution, Science, and a comprehensive health care system be elected. As Pogo stated succinctly: "We have met the enemy, and it is US".
DD
Manhattan
Voters who keep putting Republicans in office, who believe in limited government intervention, which translates to NO Federal help whatsoever, and convey their philosophy to the voters, yet have the voters ignore what Republicans say and ignorantly re-elect them are the real culprits in this malaise. If Republicans in any of the other countries mentioned were to tell the people this, they wouldn't be elected dog catcher. Only in a poorly educated country such as the United States could Republicans who deny Climate Change, Evolution, Science, and a comprehensive health care system be elected. As Pogo stated succinctly: "We have met the enemy, and it is US".
DD
Manhattan
11
It is actually much easier to fund and provide health care for a SMALL population like Canada than for a huge vast population like the US -- Canada is not very diverse, being almost entirely white and asian. They have very few black people, most are educated Caribbean immigrants and virtually no hispanics, and NO ILLEGAL IMMIGRATION.
Canadians are will to pay far higher taxes, and of course we all know they are not obligated to be the "world's policeman" and pay out of pocket to defend everyone else.
Every nation mentioned depends on the US for defense, and doesn't pay their fair share of what this costs -- that's where "the money comes from!"
Canadians are will to pay far higher taxes, and of course we all know they are not obligated to be the "world's policeman" and pay out of pocket to defend everyone else.
Every nation mentioned depends on the US for defense, and doesn't pay their fair share of what this costs -- that's where "the money comes from!"
1
What's wrong with Medicare for all with drug pricing controls and out of pocket costs kept to a minimum? It's worked pretty well for our seniors and disabled folks for 52 years. BernieCare for all as soon as possible.
4
In the Pledge of Allegiance, the United States to stand for "liberty and justice for all. If we apply that criterion to health care, a single-paye system is the only way to achieve a just solution for young or old, wealthy or not wealthy, employed or unemployed, healthy or not healthy, male or female, native-born or naturalized or legal resident or green-card visitor...
1
I didn't see any discussion of complex and burdensome bureaucracy required to get care. Has no one else experienced the US insurance run-around required to actually collect on a procedure or appointment? Has no one else ever been victim to care providers mis-coding the health care event making it nearly impossible for the patient to collect? Has no one else ever had to appeal to their insurance commissioner in order to get their insurance company to actually pay what they claimed they covered when you purchased the policy?
I have been forced to spend many hours of my time over several weeks trying to get the insurance company & care providers to simply take the appropriate billing action to gain the coverage I have already paid for. It is not uncommon to sit on hold through some rotary menu software for hours for an opportunity to talk to someone who can only read a manual of prepared statements that don't apply to you - only to be cut-off or told I need to call some other number which turns out to get me to the same rotary menu software.
If you are not part of a group plan in the US, insurance companies rape you. They make healthcare a nightmare. We have a terrible health insurance system in the US and we need a good health care system instead.
I have been forced to spend many hours of my time over several weeks trying to get the insurance company & care providers to simply take the appropriate billing action to gain the coverage I have already paid for. It is not uncommon to sit on hold through some rotary menu software for hours for an opportunity to talk to someone who can only read a manual of prepared statements that don't apply to you - only to be cut-off or told I need to call some other number which turns out to get me to the same rotary menu software.
If you are not part of a group plan in the US, insurance companies rape you. They make healthcare a nightmare. We have a terrible health insurance system in the US and we need a good health care system instead.
8
Your article missed some key points about Australias system. Its funded by a 1% tax n earnings - no tax dodges apply. Everyone who earns more than a threshold is also required to purchase private insurance. Rebates are controlled, and reimbursement for drugs is controlled, but individual choice always remains. Its a pity that your experts - whilst well intentioned - hadn't actually been a part of these systems to judge comparative value as a user.
5
You really can't compare the American medical-industrial complex with other developed countries.
Other countries have health care systems, whose goal is to provide universal access to health care for everyone. They differ in implementation, and can be compared with metrics such as efficiency, outcomes, and wait times. But they all operate under the premise that health care is a right for the citizens of their countries.
The United States is unique in having no health care system, and regarding health care (officially called "medical loss") as a privilege for the well-employed and the wealthy. Thus, a fragmented, dysfunctional medical-industrial complex has evolved with the singular goal of maximizing the wealth of executives and shareholders of the corporations that comprise it. Some of those corporations profit from delivering high-cost health care to patients (hospitals, HMOs, medical groups, dialysis chains). But the complex also includes rentiers that make tremendous profits, though they deliver no health care and even impose formidable barriers to obtaining care (insurance companies, pharmaceutical benefit managers). The complex also expends considerable resources on duplicative bureaucracy (billing and coding) that provides no health care.
It's not surprising the American wealth care system falls short on metrics comparing health care systems. But if you measure profit, investor return, and CEO compensation, we leave the rest of the world in the dust!
Other countries have health care systems, whose goal is to provide universal access to health care for everyone. They differ in implementation, and can be compared with metrics such as efficiency, outcomes, and wait times. But they all operate under the premise that health care is a right for the citizens of their countries.
The United States is unique in having no health care system, and regarding health care (officially called "medical loss") as a privilege for the well-employed and the wealthy. Thus, a fragmented, dysfunctional medical-industrial complex has evolved with the singular goal of maximizing the wealth of executives and shareholders of the corporations that comprise it. Some of those corporations profit from delivering high-cost health care to patients (hospitals, HMOs, medical groups, dialysis chains). But the complex also includes rentiers that make tremendous profits, though they deliver no health care and even impose formidable barriers to obtaining care (insurance companies, pharmaceutical benefit managers). The complex also expends considerable resources on duplicative bureaucracy (billing and coding) that provides no health care.
It's not surprising the American wealth care system falls short on metrics comparing health care systems. But if you measure profit, investor return, and CEO compensation, we leave the rest of the world in the dust!
21
The Swiss health insurance premium (out of pocket) for a family of 4 is 1000 chf/month, that is about $1000/months, for the basic HMO plan. Add to that 1000 chf/year flat deductible and additional 10% deductible (capped at chf 1500/year I think). Thus, on average $1200/month out of pocket payment and no employer contribution at all.
Having said that, lines in the Emergency Room are rare, while in Boston I used to spend routinely 4-5 hours at the ER of various "number 1" Harvard Hospitals and then get treated by interns who have not slept for 48 hours. The treatment is mostly OK.
Having said that, lines in the Emergency Room are rare, while in Boston I used to spend routinely 4-5 hours at the ER of various "number 1" Harvard Hospitals and then get treated by interns who have not slept for 48 hours. The treatment is mostly OK.
4
In Australia my Family of 5 including a wife with a chronic heart condition and me a chronic smoker... costs us Nothing for the public system (except a1% levy on income)
However we also have taken up the top Tier Private health insurance available that covers costs for dental, Private hospital, specialist of choice, Mental Health, Therapy, Gym, acupuncture, Maternity, etc etc
This Top Private Health Insurance covering us all costs me A$280 a month (US$190 a month)
However we also have taken up the top Tier Private health insurance available that covers costs for dental, Private hospital, specialist of choice, Mental Health, Therapy, Gym, acupuncture, Maternity, etc etc
This Top Private Health Insurance covering us all costs me A$280 a month (US$190 a month)
Not challenging the results, but the following is false : "In Canada, the government finances health insurance, and the private sector delivers care."
The private sector does deliver some care but almost all hospitals are public, not private; most doctors are paid (by the act) by the state. I stepped out of my local public hospital after a two-week stay (heart) and paid not a cent for the care provided, or the follow-up for that matter. The error is rather serious given the context.
The private sector does deliver some care but almost all hospitals are public, not private; most doctors are paid (by the act) by the state. I stepped out of my local public hospital after a two-week stay (heart) and paid not a cent for the care provided, or the follow-up for that matter. The error is rather serious given the context.
12
I have lived in France, Canada, Switzerland and the U.S and have used health services in all four. I liked the ease of access of France and the quality of Switzerland. The US is an expensive and wasteful mess. Canada was easy to use (in Québec). My favourite: Switzerland even though I have an ideological preference for France.
6
Our panelists give high marks to the US for innovation, while only one mentioned that US innovation is given out to the rest of the world as a form of welfare. This is certainly the case with prescription drugs. The rule of thumb in a capitalist system is that if you innovate you charge for the service. The problem with American innovation is that only Americans are paying for it. Having an expert panel that values American innovation that penalizes Americans seems misplaced.
6
The US is second to Germany in prescription drug exports. Does that mean Americans are relying on German welfare? Of course not.
There are intellectual property rights outside the US and pharmaceutical companies (American or otherwise) use them to maximise profits. They wouldn't export otherwise.
The excessive cost in the US is down to inefficient, crony capitalism.
There are intellectual property rights outside the US and pharmaceutical companies (American or otherwise) use them to maximise profits. They wouldn't export otherwise.
The excessive cost in the US is down to inefficient, crony capitalism.
3
The innovators profit from the rest of the world just fine. The difference is that in the US Republican legislators block any price negotiations for the country as a whole ensuring that nothing impedes the level of gouging. And in turn those Republicans receive huge amounts of campaign financing and even it seems special opportunities to enrich themselves personally if the allegations against Tom Price about buying stock in special deals are indicative and true.
1
This is an exceedingly odd "tournament." It downplays the difference between Canada, a "single payer" nation, and the United Kingdom, with something more like a "single provider" system. It downplays the fact that health insurance companies in other nations are heavily regulated, more like public utilities than the American form of insurance companies.
Some of the judges choose "better" health care systems based on political acceptability. No. The goal of examining other countries' health care finance and implementation must be producing better outcomes for less overall cost here at home.
Some of the judges choose "better" health care systems based on political acceptability. No. The goal of examining other countries' health care finance and implementation must be producing better outcomes for less overall cost here at home.
6
The Swiss system works well and is inexpensive. I had a 1 a.m. kidney stone attack in Geneva, Switzerland last October. (Attack is the right word, but that's another story). About 6 a.m., I took a cab to the ER at the big University hospital, was seen immediately and administered an IV painkiller within ten minutes. They put me in a ward with about five other people, where I was able to sleep a few hours. About 11 am, I was taken to see a physician, who prescribed a week's worth of non-opioid pain killers (which worked just fine). I left the hospital about noon and paid my bill on the way out the door. 205 Swiss Francs, total, for the ER visit, physician consult and medications administered by the ER. That's about $225.00. They wanted to do a CT scan of the kidney, but that would have cost $500. I declined.
2
Thanks for the concise summaries, and comparisons, of these different national approaches and programs. And interesting that none of these plans comes close to the simplistic model that many people seem to support: universal and unlimited access, without fees, and both funded and managed by the federal government. Of course, neither does US Medicare, suggesting that simple sloganeering ("Medicare for all!") reveals at least a lack of knowledge, and perhaps even willful ignorance.
1
Medicare for all would provide good basic care for the entire population. Yes, there are costs to be borne by the patient. For the poor those are covered by Medicaid and for the middle class covered by Medicare supplements. And you are wrong, Britain provides "universal and unlimited access". I don't think the "Medicare for All" folks are advocating zero co-pays or premiums. Medicare already has both.
2
Bernie Sanders is advocating zero co-pays and no premiums with funding coming from taxes on employers equal to about what large ones pay toward employee health insurance now and likely a similar increase in the amount employees pay towards Medicare encompassing what they pay for health insurance. Ideally there would also be an income tax component covering those who take most or all of their income as dividends. Between those three sources there would be plenty of money. I'd support taking that burden off of those who have only Social Security for retirement but those with substantial retirements could be fairly assessed by an income tax component too. Isn't that better than Medicare today? And I'd hope that just as veterans would then have access to all healthcare providers that the VA facilities would be available to all and even expand for doctors and staff who prefer a public salary rather than running their own business or working to enrich someone else's business.
2
Steve, while Medicare and even Medicaid would offer improvements for SOME Americans, many would be far from satisfied. And as you said, getting more complete coverage in the Medicare system requires supplemental insurance (and associated costs).
Britain may provide universal access, but far from unlimited services. And if you believe at least some of what UK critics are saying, the program faces serious financial challenges.
Britain may provide universal access, but far from unlimited services. And if you believe at least some of what UK critics are saying, the program faces serious financial challenges.
just wanted to say i am a u.s. citizen who resides in france married to a french citizen. i am covered medically in france due to my wife's citizenship and employment. i was cured from cancer 2 years ago. i went through the whole nine yards - chemo and radio therapy, surgery, multiple mri's, pet and ct scans, etc., etc. i don't think it cost me more than $100 out of pocket over a year of treatment. sure my wife is taxed more than i am in the u.s., but if you ask me which i'd take? gimme france. they've got their priorities straight.
38
There's no contest.
The United States is by far and away the greatest healthcare rip-off in the world...and it's profoundly inefficient...and it doesn't come close to universal coverage....what's not to be ashamed of ?
All in all, the American system is an international healthcare extortion disgrace.
Country & Healthcare Spending as a % of GDP
United States 17.2%
Switzerland 12.4
Germany 11.3
Sweden 11.0
France 11.0
Japan 10.9
Netherlands 10.5
Norway 10.5
Belgium 10.4
Austria 10.4
Denmark 10.4
Canada 10.3
United Kingdom 9.7
Australia 9.6
Finland 9.4
New Zealand 9.2
Spain 9.0
Portugal 8.9
Italy 8.9
Iceland 8.6
Slovenia 8.6
Chile 8.5
Greece 8.2
Ireland 7.8
Korea 7.7
Hungary 7.6
Israel 7.3
Czech Republic 7.2
Slovak Republic 6.9
Estonia 6.7
Poland 6.4
Luxembourg 6.3
Mexico 5.8
Latvia 5.7
Turkey 4.3%
http://stats.oecd.org/Index.aspx?DataSetCode=SHA
America effectively pays an annual $1 trillion surtax for shady healthcare due to its outrageous price tag.
We're #1 in medical extortion.
The United States is by far and away the greatest healthcare rip-off in the world...and it's profoundly inefficient...and it doesn't come close to universal coverage....what's not to be ashamed of ?
All in all, the American system is an international healthcare extortion disgrace.
Country & Healthcare Spending as a % of GDP
United States 17.2%
Switzerland 12.4
Germany 11.3
Sweden 11.0
France 11.0
Japan 10.9
Netherlands 10.5
Norway 10.5
Belgium 10.4
Austria 10.4
Denmark 10.4
Canada 10.3
United Kingdom 9.7
Australia 9.6
Finland 9.4
New Zealand 9.2
Spain 9.0
Portugal 8.9
Italy 8.9
Iceland 8.6
Slovenia 8.6
Chile 8.5
Greece 8.2
Ireland 7.8
Korea 7.7
Hungary 7.6
Israel 7.3
Czech Republic 7.2
Slovak Republic 6.9
Estonia 6.7
Poland 6.4
Luxembourg 6.3
Mexico 5.8
Latvia 5.7
Turkey 4.3%
http://stats.oecd.org/Index.aspx?DataSetCode=SHA
America effectively pays an annual $1 trillion surtax for shady healthcare due to its outrageous price tag.
We're #1 in medical extortion.
124
medical extortion is the correct way to describe it. usa is a disgraceful, medieval medical system where lobbying controls and blocks innovation from other parts of the world from entering and competing on its monopoly. expensive and for the most part poor service and outcomes. as my 87 year old dad says- most doctors in the usa are just salesmen... .
1
Right on. I would have taken the French or German health care systems before Medicare at age 65. Little use in prior 20 years of self employment; made sure I never lapsed for fear of the dreaded prior illness I may not now about being excluded.
1
I think it is important to differentiate a few things.
High quality Medicine (new technologies) is NOT the same as health care. I have had excellent surgery with the latest tools but very poor and unorganized care before and after that caused too much unnecessary suffering and much higher costs than needed.
Also research into new medical technologies is NOT health care. We may have the most advanced biomedical research but as above that is only a part of health care.
High quality Medicine (new technologies) is NOT the same as health care. I have had excellent surgery with the latest tools but very poor and unorganized care before and after that caused too much unnecessary suffering and much higher costs than needed.
Also research into new medical technologies is NOT health care. We may have the most advanced biomedical research but as above that is only a part of health care.
11
It seems that we are behind most other countries in this area, even though many Americans still buy into the horror stories that the GOP and right-wing pundits put out about the Canadian and UK health systems. I don't think we could create and adapt to an NHS immediately, but we could certainly enact laws or policies that would control spiraling drug costs, give people access to some basic healthcare services even if their work does not provide insurance, and phase out the FFS model more quickly. We pay a lot for healthcare in this country, but have poor outcomes compared to other systems. People cling to the status quo because the political crowd in DC and the companies who profit off the current system will fight change all the way.
7
I live in Canada. The description of the health services here is incorrect., which makes me wonder what else is incorrect in this piece. For example, where I live, everyone has access to prescription coverage. What coverage you get depends on your income. In my case (I make 100K annually), any costs that exceed $3500 annually are paid 70% by the plan. Once my co-pay hits $4,000, the plan pays 100% of any further costs, including dispensing fees. This can vary province-to-province. It is true that doctors do run their own practice, but hospitals are run by the governments, they are NOT private, as the article insinuates. Ancillary services, such as lab work, x-rays, ECG etc are paid 100% by the healthcare plan.
12
There may be a place for a free market in some aspects of healthcare, but that presupposes you have a choice. In an emergency you don't. And even if you can choose then (at least in the US) you don't typically have the information to make the choice. Then you can discover oddities such as the emergency room being 'in network' but none of the doctors that treat you are. Only of course when you get the bill.
4
Or you discover that your U.S. Health Insurer hasn't contracted with local hospitals. So a surgical procedure can cost you full "rack rates". Which your limited insurance may not cover.
I was there, ended up travelling North to Montreal Canada for a spinal fusion instead of taking a chance with full Rack Rates in Vermont..
Had an excellent outcome.
I was there, ended up travelling North to Montreal Canada for a spinal fusion instead of taking a chance with full Rack Rates in Vermont..
Had an excellent outcome.
4
USA is the only nation with stories of people going bankrupt or unable to afford medication do to the cost of health care.
9
I take it that you didn't list the Scandinavian countries in order to preclude a five way tie for first place.
4
No Taiwan?
1
I have had experience with the German system. My husband was working here and I got sick and needed to be hospitalized. The care was completely free and I got well quickly. I shared a room with a Turkish woman who had burned her hand at work in a laundry. She had already been there a week and got completely free care. This is the kind of care we need in the US for all citizens (and visitors!)
5
Missing from this analysis is the exorbitant load malpractice insurance and payouts places on the medical profession in the USA. If a surgery or treatment doesn't have the desired outcome - and you prevail in court, well, it's kinda like winning the lottery for you and your legal team. Malpractice litigation in the USA must be factored into medical costs because the insurers sure do. Estimates range from 2% to 10% of the total. That's a cost estimate ranging from 55 billion to 275 billion dollars. Part of the solution to realizing affordable healthcare must therefore include either placing a cap on damages or enacting legislation outlawing vexatious litigation and fairytale Powerball sized settlements.
2
Or getting better doctors ! Hospital mortality rates per 100,000 people in the U.S are 120 versus 60 in Australia as just one example.
Perhaps if Doctors and hospitals were more competent in the U.S the costs of Litigation would not factor so heavily in the system.
Perhaps if Doctors and hospitals were more competent in the U.S the costs of Litigation would not factor so heavily in the system.
2
Another side of malpractice happened in my red state where in a year before mandatory arbitration became optional out of nearly 2,000 cases the patient involved received nothing. Yet the malpractice insurance premiums continued to rise because it is yet another area with unlimited profit levels it seems. We need a system where actual harm is compensated appropriately and where negligent and/or incompetent practitioners are sorted out rather than shuffled away to harm more unaware patients. A first step I think would be to make medical associations in each state collectively liable and self insuring. They could by reinsurance as a group but the motivation to refuse to police their profession would hopefully go away and actual malpractice would be substantially reduced.
1
States that have instituted "reforms" that have substantially reduced the number of malpractice suits have not reduced the cost of health nor the frequency of tests and treatments. Defensive medicine is a myth. In fact, in a letter to Senator Hatch, the CBO wrote that an ideal system of tort reform would not lower costs by any more than 0.5%, 0.3% of which would be due to less "defensive medicine,"
References: page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, and http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
References: page 150 ff of http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf, and http://www.cbo.gov/ftpdocs/71xx/doc7174/04-28-MedicalMalpractice.pdf,
Here is the relevant paragraph from the letter to Senator Hatch:
"CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services."
1
For much more comprehensive coverage (without the tournament), read "The Healing of America" by T.R. Reid. Written before the ACA was passed, he traveled the world with a bum shoulder to sample recommendations, wait times, and costs. From the extremes of US (total shoulder joint replacement, months of waiting, and high cost if not covered) to the UK (sorry that you can't play golf but here's some free PT, if you decide on private surgery you can get it soon and at reasonable cost), there are many variables among the countries.
His thesis is that universal health care coverage is a right, and surely the US can find approaches among all that diversity that will work for us.
His thesis is that universal health care coverage is a right, and surely the US can find approaches among all that diversity that will work for us.
3
This article fails to place the Swiss system in the proper context, which is particularly galling as some of the lacunae are mentioned in the other country summaries. Mandatory basic insurance limits Swiss patients to public hospitals, and, except in cases of emergency, in-canton public hospitals. A higher share of Swiss expenditure is public (63.6%) than in the US (49.1%) because its hospital system is public. The US does not have a public system comparable to this. The structure of hospitals was mentioned in the context of other countries, but not Switzerland.
Swiss out-of-pocket expenditure is the highest in the world at $2,275 in 2016. USA? $1,054 in 2015, the latest year available. As a proportion of total health-case expenditures, it'd involve shifting more expenses onto people than our current system (11.1% of total expenditure in the US vs. 28.7% in Switzerland). Americans have greeted recent attempts to shift costs like this quite negatively.
I won't get into Tarmed, as it is indirectly mentioned ('Most doctors work on a national fee-for-service scale'). That could be something worth pursuing at present in the US, but I suspect that people who love "markets" will object vehemently. That's what I find quite strange about support for the Swiss system. Prices are highly regulated.
All numbers are from the OECD.
Swiss out-of-pocket expenditure is the highest in the world at $2,275 in 2016. USA? $1,054 in 2015, the latest year available. As a proportion of total health-case expenditures, it'd involve shifting more expenses onto people than our current system (11.1% of total expenditure in the US vs. 28.7% in Switzerland). Americans have greeted recent attempts to shift costs like this quite negatively.
I won't get into Tarmed, as it is indirectly mentioned ('Most doctors work on a national fee-for-service scale'). That could be something worth pursuing at present in the US, but I suspect that people who love "markets" will object vehemently. That's what I find quite strange about support for the Swiss system. Prices are highly regulated.
All numbers are from the OECD.
3
also, it's getting more expensive every year. It's been like this for years and it's not going to change anytime soon. I already know that next year I will probably have to pay 10 - 20 francs more per month. And I already pay over 400 francs a month, and that's for basic healthcare only. And I make less than 6000 francs a month and no, I don't get any deductibles. Yes, we have excellent health care, but every year it's getting harder and harder to pay for it. And those national fees? Well. if you have a chatty doctor, you're going to pay extra. Because you get billed for every single minute you spend at your doctor's. So no, doctor, I don't want to talk about my work and I don't care about your children. I want to tell you what hurts and I want you to tell me what's wrong. Amd that's it.
2
Innovation is directly correlated with quality of care. It would have been helpful to see a comparison of each nation's investment in innovation as a percent of GDP. There is no question that the US stands far and above all other nations in innovation, and this includes the US inventions of polio vaccines, birth control pills, whole organ transplantation, and new immune therapies for cancer.
But not so well in Hospital/Patient Mortality Rates or overall patient outcomes in the Health System.
See haere for more:
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
See haere for more:
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
1
Many drugs and medical instruments were discovered abroad. For example, the most prescribed drug type, statins, were discovered by 3 Japanese academics and MRI's were develop in SUNY (US) and U of Nottingham (UK). Drug companies spend about 11% of their budget on R & D, 20% on profit and 34% on marketing. (Alan Sager) While we used to spend more (51% in 2007) than the rest of the world on medical R& D, now we spend less (45% in 2012) and our percentage is falling. https://www.usnews.com/news/articles/2014/01/02/us-medical-research-spen...
If you have any references to your claim that the US produces more innovation then one would expect from its size and wealth, I would love to see it.
If you have any references to your claim that the US produces more innovation then one would expect from its size and wealth, I would love to see it.
4
In our discussions of countries that rely on private insurance we must not forget that US Health Insurance companies have had over 30 years experience in not covering sick people, evading contractual obligations, loading most of the cost of illness on sick people and manipulating government to get their own way. If we had German insurance companies the German plan might work. Ours are hopelessly corrupt.
8
I am still digesting the information laid out in this timely and thought provoking article. My main comment would be simply to thank the "fake-news" Times for such worthwhile journalism. I only wish more media outlets would address the critical issues of the day in such a balanced and creative way. My $15/month subscription fee is probably the best investment I ever made. Keep up the good work.
4
What isn't mentioned here is that Briton rations drugs and/or does not make them available at all through a system bearing the horrendous acronym NICE. Hospitals are hopelessly understaffed, badly managed and hotbeds for infectious disease (immune-suppressed patients sharing bathrooms - in one of the most modern facilities in London). Access is shambolic, waiting times are endless, especially in the big cities. There is NO choice of primary care doctors, you have to go where the state tells you to go. There is hardly any dental care. Nobody in Europe considers the UK to have health care on the level of an advanced industrialized country.
3
Britain has finite resources, just like every other country in the world. Everywhere rations healthcare: the US rations drugs according to the ability to pay, which takes some mental gymnastics to argue is better than rationing according to effectiveness and cost.
The USA has higher MRSA infection rates than the UK - and all other G8 countries.
And the best bit? Americans spend twice as much as Britons and live shorter lives.
The USA has higher MRSA infection rates than the UK - and all other G8 countries.
And the best bit? Americans spend twice as much as Britons and live shorter lives.
1
Unfortunately, comparison reports of each countries Health systems on those measures you mention and more don't agree with your feelings and opinion, which is not to be considered as fact and accurate.
Read a real report on different health Systems and how they rank against each other Here: http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
Read a real report on different health Systems and how they rank against each other Here: http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
2
Let's compare some bottom line statistics between the US and the UK:
Life expectancy at birth (OECD):
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000) (OECD):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
Life expectancy at birth (OECD):
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000) (OECD):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
1
I wish you had used Japan instead of Singapore. The population of Singapore is smaller than that of London (by itself). It doesn't deserve to be compared to the much larger populations of the USA, Britain or Germany. Not the same ball park.
1
Our country, the United States, has the potential and in some cases already has the best health care professionals in the world. The mess we have is due to the infiltration of financial institutions and big money in to this area at the expense of all but the poor or middle class. If only we could have a medicare based system for all with a private medical insurance and providers, as an add-on for those who want and can afford more - the core population of this nation could enjoy better health care and the super-rich can also get what they want. The private insurance providers will need to down-size/get out of the business and the pharma folks will have to come down to earth,
8
The real test is what do the population gets for its money whether paid as taxes (universal health coverage) or a mix of taxes and private insurance (two tiered other systems). Having administered both the US and Canadian health care systems for over 15 years as a director of university-affiliated cancer centers and having simultaneously researched cancer outcomes, I can comment on the US-Canada comparison. In terms of access for all individuals to modern cancer treatment, the Canadian system is distinctly superior to the US. In terms of overall population outcomes as measured by survival from cancer there is no difference. In short, the Canadian system delivers identical results at approximately 2/3 the cost. The rest of the money spent on cancer care in the US goes to the providers of health care delivered as a commercial commodity.
5
The best plan would be to pick and choose various elements from all the countries that currently have universal coverage. They have already done the hard part for us. We are in the perfect position to leverage what they have learned.
5
You are right! Unfortunately what is best and good for you and the majority of Americans is not considered important as compared to the profits that can be made by those who wish to make it at the expense of anything best for the Citizen/customer/patient/taxpayer...
2
At the end of a discussion , Uwe Reinhardt, one of the people in the article, wrote to me. "Americans are too immature to learn from others."
Rather than finding the best health care system we would be better served by finding out why there re 35 countries that are heather than we are.
I am of the opinion that the single minded government policy to feed us as cheaply as possible is a major cause.
From the 1915 bleached bread decision to putting aspartame on the market our system is devoted to profit at the expense of the country's health. It is a truly sad situation.
I am of the opinion that the single minded government policy to feed us as cheaply as possible is a major cause.
From the 1915 bleached bread decision to putting aspartame on the market our system is devoted to profit at the expense of the country's health. It is a truly sad situation.
2
Great idea for an article, but a shallow methodology.
Why are we just consulting US experts, and why are we making it a point scoring contest like fantasy football? None of them seem to have any direct experience with these systems. Why not interview, for example, a German doctor now practicing in Melbourne? Or a woman who delivered one baby in Britain and another in Paris? How about a discussion of consistency of care throughout the country? Do Aboriginal communities have the same access to quality care as residents of Sydney?
There is also no discussion of the different types of care needed. The care and infrastructure needed to treat a broken bone is far different from cancer is different from obstetrics.
While I appreciated the general outlines of each system, I am finding the comments from other readers below far more enlightening than the point scoring of your panel.
Why are we just consulting US experts, and why are we making it a point scoring contest like fantasy football? None of them seem to have any direct experience with these systems. Why not interview, for example, a German doctor now practicing in Melbourne? Or a woman who delivered one baby in Britain and another in Paris? How about a discussion of consistency of care throughout the country? Do Aboriginal communities have the same access to quality care as residents of Sydney?
There is also no discussion of the different types of care needed. The care and infrastructure needed to treat a broken bone is far different from cancer is different from obstetrics.
While I appreciated the general outlines of each system, I am finding the comments from other readers below far more enlightening than the point scoring of your panel.
25
bill....my first thought was why did they all seem to be americans or at least working in the usa.
6
Unfortunately this is all very politicized by the hard-left wing NYT.
I wonder why there are not journalists and investigators, who could do a very complete analysis of each system listed here -- Europe, Canada, etc. -- and detail it, and compare it to the US....remembering that WITHIN the US are numerous very different insurance systems (VA, Tricare, Medicare, Medicaid, HMOs, PPO, private insurance, cadillac insurance, etc).
Otherwise, you are comparing apples to oranges.
I wonder why there are not journalists and investigators, who could do a very complete analysis of each system listed here -- Europe, Canada, etc. -- and detail it, and compare it to the US....remembering that WITHIN the US are numerous very different insurance systems (VA, Tricare, Medicare, Medicaid, HMOs, PPO, private insurance, cadillac insurance, etc).
Otherwise, you are comparing apples to oranges.
1
As always and in every publication, the quality of comments far surpass the original offering.
It has been observed that in the US the federal, state and local governments currently spends MORE than the UK on healthcare (adjusted for population and exchange rate) through medicare, medicaid, VA, insurance, military benefits, etc. and we don't even have universal coverage. Another nation with an excellent national healthcare system to consider is Israel which has much better outcomes at a fraction of the cost in the US and covers everyone.
2
A quick note to the Britain vs. Canada match. I'm Canadian and my older sister is a Brit. We are 3 years apart in age. I can say in terms of preventative healthcare, Canada is the winner hands down. I have far greater access to pap and mammograms, colonoscopies etc. My Sister is unable to get these in UK without having some diagnosis of a problem first.
12
A number of years ago, we spent a year in Scotland. Our teenage son developed what seemed to be a food allergy, and we took him to the local GP. This guy was great! He even made a house call. In order to determine the cause of the allergic reaction, he suggested we see a consultant (specialist). We made an appointment--for about three months later. When we showed up (at a rather shabby facility at Glasgow University, the doctor took one look and said, "Make a new appointment. There is too much inflammation to do the test." We did so and returned in a couple of months. Same result. We gave up. Those two experiences (the GP and the consultant)epitomized our experience with the NHS.
2
Back in the "old" days before Nixon, it was illegal to make a profit providing tests and insuring patients etc. Then along came Mr Kaiser who talked Nixon into proposing for profit health care to allow Managed Care which was supposed to solve everything. Of course it didn't. Insurance companies were what are called 'mutual' companies. The members paid premiums and if there was excess money generated by the mutual company's investments it went back to the members. That still seems like a good idea. Testing companies and the ERs should be non-profits and regulated to control costs. Medicare for All is a viable plan as it spreads the cost across all people. Why do private companies want to be involved in your health insurance? Is there a profit for them in it? Seems like they'd like to be shed of that responsibility. Government run payment systems would make it easier for startup businesses to get going as medical insurance is a huge burden on young companies. Maybe that's one of the reasons the giant corporations want to control it, to dampen competition. We would all be more free if we didn't have to worry about this stuff.
5
It's outrageous and unbelievable that this panel was formed completely of men.
8
c wolfe....just as unbelievable they're all americans or working in the usa. be nice to have some outside view. it's often how americans get into trouble....navel gazing without a clue about what's going on with the other 95% of the world's people.
1
I am a dual US and UK citizen, living in the UK. I use the NHS regularly, and also have private insurance top up which I use occasionally. I am delighted with the level of care, professionalism and compassion I have experienced at the NHS.
5
To understand the Swiss model of private insurance with a system that's been in place in the US for a hundred years think energy utilities, private or semi-private companies that are often guaranteed a profit but has its operations costs and charges publically regulated to hold down costs.
1
About 20% of "healthcare" spending in the US is for marketing and administration -- a total waste. I'm paying much more for Medicare and Medicare supplement than I ever paid as an employee -- and that doesn't include extra fees to see my PCP on a same day or next day basis. As a frequent traveler, I've received better care in France, Germany, New Zealand and Argentina and at nominal cost. The US system is good for physicians -- not for the rest of us.
12
Good for physicians? Good for the insurance and drug companies you mean.
3
There is no analysis of outcomes in the various national systems.For example would you want a 70% chance of survival of the three major cancers in Canada versus 52 % in the United Kingdom after 5 years as the most recent edition of the Economist emphasized.As the Guardian has reported in recently the NHS is on the verge of collapse.An equally important consideration is whether everyone has health care in the country as a prerequisite for comparison-otherwise you have a false equivalence
4
I'll just post the link with a quote here:
https://www.economist.com/news/leaders/21728893-science-will-win-technic...
" The five-year survival rate for a set of three common cancers in America and Canada is above 70%; Germany achieves 64%, whereas Britain manages a mere 52%."
https://www.economist.com/news/leaders/21728893-science-will-win-technic...
" The five-year survival rate for a set of three common cancers in America and Canada is above 70%; Germany achieves 64%, whereas Britain manages a mere 52%."
4
The US and UK have polar opposite approaches to prostate cancer. In the US, it's a common yearly test after 30 or so. In the UK, there is no testing unless an issue is reported. I purchase a PSA test now on my annual visits to South Africa (total cost about $50)
"There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks."
http://www.nhs.uk/Conditions/Cancer-of-the-prostate/Pages/Prevention.aspx
"There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks."
http://www.nhs.uk/Conditions/Cancer-of-the-prostate/Pages/Prevention.aspx
No matter how wonderfully innovative new healthcare treatments are, they don't do a bit of good to those who can't afford them. Yes, basic quality of care matters, but it seems most places deliver decent basic care without subjecting their populace to the nightmarish financial stressors we experience in the US even for those with coverage. If you have not yet experienced cancer or other major illness and think that you have adequate coverage - good luck. Our wonderful innovations are currently carried on the backs of the un- or under-insured.
14
So the UK's health system is worthy of emulation? It was dismissed by many as an evil death panel when it refused further treatment of Baby Gard. Where did the parents look for further treatment? The "broken" health system of the US.
2
lynn...and how many thousands of americans died because they were denied because they didn't have the money or because they delayed going until it was too late?
6
Comparing Britain and Canada on wait times is pretty interesting, since typically wait times are used to bash Canadian system when it comes to comparing with US. However, the data on comparing Canada with UK is sparse.
The only reasonable link I've found it this OECD data for three surgeries, where UK does a better job than Canada for 2 out of 3 surgeries. On an interesting side note, though, it looks like Australia has worse wait times than either of the two countries, which raises some interesting question about wait time comparison:
http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-...
The only reasonable link I've found it this OECD data for three surgeries, where UK does a better job than Canada for 2 out of 3 surgeries. On an interesting side note, though, it looks like Australia has worse wait times than either of the two countries, which raises some interesting question about wait time comparison:
http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-...
1
If the real question were related to how we select quality in care for all, a different and much less superficial question than one can get by comparing nations in the absence of quantitative data, I would be much more interested. I graduated from medical school fifty-two years ago. In my view and in the views of most older patients, our current system for healthcare fails to address the needs of most patients with complex and/or multiple illnesses. Based on watching and participating in healthcare at both of the major institutions in Cleveland, the Cleveland Clinic (CCF) and University Hospitals (UH), physicians are under enormous pressure to hurry and to order expensive tests. A month ago, I was told by a neurologist who is employed at UH, that every neurologist at UH had received a letter recently stating that they could be terminated on short notice if they saw fewer patients than the median number of patients seen by all neurologists at UH. I asked another UH neurologist if this was true; his response: "That is the way it is." While modern technology has added valuable tools in patient care, physicians must have ample time to interview, examine, and select treatments for patients. Neither UH nor CCF view taking sufficient time with patients, physicians consulting peers about difficult cases, or taking time to carefully consider alternative treatments as very "valuable" (billable). The space available precludes my citing examples of the decline in quality of care.
9
I am just wondering what about demographics? Which works better when you have a large %age of the population that is poor and unemployed or marginally employed? I don't many of these countries dealing with the same issues the US or even UK has.
1
That's a good point, but France has much higher unemployment and a substantially size under employed population, primarily minority. Unemployment is France is at around 11% and underemployment is as high as 35%.
Germany's unemployment rate today is good, about 3.8% but in the not so distant past, 2007 was around 8.7%.
The biggest reason Americans declare bankruptcy is due to medical costs and it's a major factor in explaining divorce too. Better healthcare for Americans could improve the demographics here.
Germany's unemployment rate today is good, about 3.8% but in the not so distant past, 2007 was around 8.7%.
The biggest reason Americans declare bankruptcy is due to medical costs and it's a major factor in explaining divorce too. Better healthcare for Americans could improve the demographics here.
5
One type of single-payer that I was hoping to get discussed was the Taiwanese system. It is financed through a payroll tax and outcomes in terms of life expectancy and access has been significantly improved since its implementation. Having experienced both the Canadian and Taiwanese system, I think there is a danger to increased access that is not discussed. In Taiwan, patients seek care for common colds and flu because of the cheap cost and short waiting times. Ease of access has also led to the crowding of hospitals with doctors seeing patients for a very short amount of time. The cap on health spending has also led to cost-cutting and reduced service fees for physicians, which has made the medical profession less attractive. The dangers of low-cost and guaranteed coverage may seem like propaganda for pharmaceutical companies and medical associations, but there is some legitimacy to that argument.
I second ebmargit's comments re: simplicity. I am an American who lived in Europe for 6 years in Spain, Sweden and Germany. In Spain and Sweden the system is similar to the UK NHS. Care is essentially free for everyone legally living in the country. You simply walk in to a hospital or doctor's office and get treated. That's it. You don't have to double check your insurance or compare or wonder if the doctor is in your network or worry how much this will cost you. The value of that simplicity and ease of the system should not be undervalued.
Residents of Spain and Sweden don't worry about their healthcare. They know it will be there when they need it. This is evidenced by the fact that I never had a discussion with any of my friends about concerns about healthcare. It is an area of concern that is simply removed from life. How wonderful, especially for families and those with serious diseases.
The elimination of concern over healthcare generates enormous benefits. People can change employers without losing healthcare, you can move from one city to another, have children without needing to save money for medical costs, etc. This enables entrepreneurship and freedom in the job market. Perhaps more importantly, it removes an enormous mental burden that I feel constantly now living in the U.S. again. The mental health benefits of government run healthcare are enormous.
Residents of Spain and Sweden don't worry about their healthcare. They know it will be there when they need it. This is evidenced by the fact that I never had a discussion with any of my friends about concerns about healthcare. It is an area of concern that is simply removed from life. How wonderful, especially for families and those with serious diseases.
The elimination of concern over healthcare generates enormous benefits. People can change employers without losing healthcare, you can move from one city to another, have children without needing to save money for medical costs, etc. This enables entrepreneurship and freedom in the job market. Perhaps more importantly, it removes an enormous mental burden that I feel constantly now living in the U.S. again. The mental health benefits of government run healthcare are enormous.
20
I agree, simplicity is important. I lived in Great Britian in the late 1970's and even as a foreigner, I had access to free or low cost healthcare. I took care of myself, but it was nice to have that worry off my mind.
6
I second EFG’s comment regarding the reduction of mental burden by having the security and peace of mind if one is able to easily obtain healthcare without the worry of cost or access. As a Malaysian living in the US and working in the US healthcare industry, the differences are stark.
While in Malaysia, I never had to think twice about healthcare. There are public and private healthcare entities but majority of citizens relied on the government run system which provided access to everyone for a minimal cost. However, even with the private hospitals, there is clear transparency of costs. All the prices are displayed in the lobby of hospitals (i.e. price per inpatient night, price per surgery)
While in the US, my constant worry is having to visit the emergency room or just being admitted. Not knowing what any medical procedure will cost is frightening to anyone. The lack of standardization & regulation are the largest factors contributing to the astronomical cost of healthcare in the US, together with the lack of transparency & administration cost. The US needs to regulate at the very least the core components of healthcare, pharmaceuticals & medical equipment.
I consider myself lucky of being able to back to my home country should I require major healthcare services (that’s my peace of mind). What about the peace of mind of the citizens of this country? Everyone deserves a right to healthcare without question. Can we not work together to provide this basic human right?
While in Malaysia, I never had to think twice about healthcare. There are public and private healthcare entities but majority of citizens relied on the government run system which provided access to everyone for a minimal cost. However, even with the private hospitals, there is clear transparency of costs. All the prices are displayed in the lobby of hospitals (i.e. price per inpatient night, price per surgery)
While in the US, my constant worry is having to visit the emergency room or just being admitted. Not knowing what any medical procedure will cost is frightening to anyone. The lack of standardization & regulation are the largest factors contributing to the astronomical cost of healthcare in the US, together with the lack of transparency & administration cost. The US needs to regulate at the very least the core components of healthcare, pharmaceuticals & medical equipment.
I consider myself lucky of being able to back to my home country should I require major healthcare services (that’s my peace of mind). What about the peace of mind of the citizens of this country? Everyone deserves a right to healthcare without question. Can we not work together to provide this basic human right?
6
I am American but live in France. I am currently a student but over the 28 year old age limit for immediate coverage. But, after 3 months residents (not just citizens) can go on French health insurance. The first few months I had private insurance but ended up just paying cash as medical care before insurance is so much lower than in the US. Doctors are either convention 1 (lowest gov approved fees), convention 2 (higher but somewhat controlled. usually specialists), and non-convention. My generalist is convention 1 (~$33 before insurance) and my specialist is conv 2 (~$95 before insurance). My prescriptions and radiology/lab work here is so much less expensive I can't even imagine how the same thing costs so much in the US. Such as: how can an MRI cost $180 here with conv2 and $1500 in the US? PRE-EXISTING or CHRONIC CONDITIONS: you get complimentary mutuale (this is the top up insurance people get through work mentioned in the article) which means 100% coverage not 70%. The US charges you more or delays coverage. Overall, it is easy for me to get appointments (most doctors and dentists have online booking), and my care is excellent. I feel a more personal approach in the medicine too, probably due to most doctors being private and the only person (no receptionist or nurses unless a group) in their office.
19
I notice that the Right is trying to counter is excellent discussion with cinjecture and ideology, not facts and figures.
The fact is, the only aspect of health care in which we lead the world is this: in some cases, very, very expensive and sophisticated surgery and drug treatments are best done in the United States. And with that, if you're very elderly or very young and hopelessly ill. it's more likely that the medical system here will string you along longer than anyplace else.
In everything else--outcomes, access, costs, public health--we're basically behind everybody.
Malcolm Gladwell summarized the matter very well: you can have a system in which everybody gets decent access at affordable costs and there are reasonable limits on the fancy stuff, or you can have a system in which a very few get everything, a majority gets so-so care and fantastic costs, and many get nothing at all. You cannothave both.
The word "fairness," comes to mind.
The fact is, the only aspect of health care in which we lead the world is this: in some cases, very, very expensive and sophisticated surgery and drug treatments are best done in the United States. And with that, if you're very elderly or very young and hopelessly ill. it's more likely that the medical system here will string you along longer than anyplace else.
In everything else--outcomes, access, costs, public health--we're basically behind everybody.
Malcolm Gladwell summarized the matter very well: you can have a system in which everybody gets decent access at affordable costs and there are reasonable limits on the fancy stuff, or you can have a system in which a very few get everything, a majority gets so-so care and fantastic costs, and many get nothing at all. You cannothave both.
The word "fairness," comes to mind.
5
Yes I agree, but I think that these more complicated "innovative" surgeries and procedures probably only apply to a very small percentage of Americans. In other words, we shouldn't be basing our healthcare decisions on procedures that a fraction of the population will need or use.
But also now with electronic media and scientific journals, chances are these innovative procedures will be easily duplicated in other countries.
Bottom line with US healthcare IMO is we need to fix the absurd cost of healthcare. Mainly rotuine procedures (X-rays, CT scan, colonoscopy, etc.) and prescriptions.
But also now with electronic media and scientific journals, chances are these innovative procedures will be easily duplicated in other countries.
Bottom line with US healthcare IMO is we need to fix the absurd cost of healthcare. Mainly rotuine procedures (X-rays, CT scan, colonoscopy, etc.) and prescriptions.
3
USA new medical system that saves 70% of current cost.
No life saving or cancer treatment for patients over 72 years old
by mandatory Canadian style public funded private provided system.
Then nearby counties and TRIBAL lands can have a total free enterprise
extended care franchise. This system can cover preventive and basic care
at a better cost and compress growth of run away exotic care.
No life saving or cancer treatment for patients over 72 years old
by mandatory Canadian style public funded private provided system.
Then nearby counties and TRIBAL lands can have a total free enterprise
extended care franchise. This system can cover preventive and basic care
at a better cost and compress growth of run away exotic care.
I'm living in the USA now, but I lived in British Columbia for 20 years. Most of my family is still there, except for my brother, who lives in Switzerland. So my family has experienced 3 of the health care systems in this article. According to my brother, the quality of health care in Switzerland is good, not as expensive as the USA, but more expensive than he would like. He has undergone a series of surgeries to repair his face after a bike accident, and he returned to Canada for those. (He was in Canada at the time of the accident and received excellent care). My experience with the Canadian system was mostly positive. I found the level of care to be no different from the USA. Only one negative: longer wait times in the doctor's office for appointments. Not unusual to wait 30 minutes after the appointment time. On the other hand, I didn't find that I was shunted in and out as quickly as I am here with Kaiser, so this may account for the wait (if previous patient's appointments ran long.) Overall I was very satisfied. I find the American system to be insanely expensive and complicated, and I am hoping for a change.
7
Why is involvement of private insurance carriers a plus in ANY of your models? It is the one driving element that monetizes disease rather than rewarding health. Private insurers and drug companies make billions off the assumption that there are diseases that are chronic and cannot be cured--when, in fact, many are easily curable with dietary and lifestyle changes, and others could be cured with a business model that sought to put itself out of business. By making privatization a supposedly positive factor in your ratings, you are ignoring the underlying issues with Western cultural health: that we do not have health systems, we have disease systems. And as long as disease can be capitalized upon, we will continue to have disease systems.
2
I have had real and sustained experience with only two systems, America´s and Spain´s. Spain´s, in this exercise, is very similar in most important regards to the French system, with the difference, an important one, that when the Spanish right is in power it does everything it can to trash the public system. The responses to that effort have been very good. All the Spanish MDs whom I have known are serious professionals committed to a well-financed and well-administered public system, and they are willing to put those views on the line. Where in America could you find massive street demonstrations in favor of a fully public healthcare system that include important contingents of both doctors and patients?
That said, America´s healthcare system works wonders for people with stable jobs and equally stable insurance obtained through the job. Nonetheless, there are factors where Spain beats America every way imaginable. It´s outcomes are very good, the costs are very acceptable and the coverage is as near universal as any in the world.
A Spanish friend, an MD, asked me not too long ago how Americans stay sane in a system that looks an awful lot like a lottery. My answer to him was that they don´t. Spain gets my vote every time.
That said, America´s healthcare system works wonders for people with stable jobs and equally stable insurance obtained through the job. Nonetheless, there are factors where Spain beats America every way imaginable. It´s outcomes are very good, the costs are very acceptable and the coverage is as near universal as any in the world.
A Spanish friend, an MD, asked me not too long ago how Americans stay sane in a system that looks an awful lot like a lottery. My answer to him was that they don´t. Spain gets my vote every time.
20
Interesting that the country with the smallest population, by far, gets the highest marks (Switzerland, 8.3 million). A Swiss poster in this thread pays approx $625 (usd) per month with an approx $500 deductible - pretty rich for most people and a non starter for people in places like Britain and Canada where taxes pay the entire bill. As a Canadian, if I had to cough up nearly $800 (cad) per month for health insurance, you can bet I'd demand the very very best (including wine and gourmet meals).
I'm happy with Canada's system (I don't really have a choice). Yes, you definitely wait for elective surgery (with the emphasis on "elective"), depending on which part of the country you live in, but if you're really sick, you get fast, excellent care. And nobody goes broke due to medical bills or having to pay astronomical premiums.
I'm happy with Canada's system (I don't really have a choice). Yes, you definitely wait for elective surgery (with the emphasis on "elective"), depending on which part of the country you live in, but if you're really sick, you get fast, excellent care. And nobody goes broke due to medical bills or having to pay astronomical premiums.
7
The American system is great if your upper-middle class/rich. If your poor, care is nonexistent other than through an emergency room visit, which if your poor, you probably wont be able to afford to pay anyway.
As someone who has lived through poverty, and also have been fortunate enough to achieve a semblance of a well to do life. Give me the French or Swiss system any day. The depraved selfishness of the American medical delivery system will be this country's downfall. Think about how much human capital has been either depressed or snuffed out entirely simply because our healthcare system doesn't give people their ability to live out their potential simply because they don't have the means.
As someone who has lived through poverty, and also have been fortunate enough to achieve a semblance of a well to do life. Give me the French or Swiss system any day. The depraved selfishness of the American medical delivery system will be this country's downfall. Think about how much human capital has been either depressed or snuffed out entirely simply because our healthcare system doesn't give people their ability to live out their potential simply because they don't have the means.
12
Years ago my dad said the one thing that could bring this country to its knees was greed. Sounds even more true today.
Further, in terms of some areas of diagnostic medical engineering, such as the use of colour Doppler flow echocardiography, Japan has been ahead of the US since the 1980s.
4
I lived in Switzeraland for two years and had local insurance. It was much less expensive than my US premium employer plan and gave much better outcomes. Example: in Switzerland, women stay in hospital for TWO WEEKS post-birth; this has great outcomes for breast feeding and child health. Example: the hospital threatened to call the Swill Child Protective Services when I wanted to take my kid out of hospital six days after her tonsillectomy. Their protocol said seven; in the US it would be less than three hours (trust me, the US goal is to get the kid out before they start vomiting). Pick your level of service and your own doctors. I had to pay for 10% of everything, very simple. Loved it.
7
As long as disease is a profit center, there will never be a true program for wellness. All one has to do is look at the decades of obfuscation about sugar. Sugar and its plethora of Western Diseases are the single largest reason our disease treatment costs are the highest and our outcomes so pure. How simple it would be to correct, but there will never be any political will do so. Follow the money.
4
I wish that Taiwan had been included in this (very fun) article. It has a unique model of universal health care from the government (now in its 22nd year) with the lowest administration cost in the world (2%). The coolest part in my opinion is the personalized medical "smart cards", filled with health care data that allow any doctor to immediately access your medical records. Of course the system isn't perfect (rushed doctors, outside payment needed for some services), but I think such an innovative model should have been mentioned.
4
France, Germany and other countries use medical cards to hold a patient's history.
1
I'm not at all convinced by the so called "dynamism and innovation" of the US healthcare sector. There is a great deal of innovation and research that goes on around the world. The market for healthcare is huge, and that isn't going to change. There are many nations that spend as much as a percent on GDP of health-related GDP, they just happen to be smaller countries. "Innovation and dynamism" a nice buzzphrase, but let's look at France vs US again. Outcomes: France > US; Cost: France > US; Access: France > US. Choosing the US system is like choosing a car that has worse handling, gas mileage, and reliability because it comes in bright red.
18
As an American couple living in Switzerland, we have both experienced the Swiss healthcare system firsthand with several major surgeries between us (Appendicitis, Prostate cancer, broken shoulder, hysterectomy). The level of care and the facilities in Switzerland are topnotch. We have each shown up to the Emergency room and been seen within minutes. The hospitals are quiet, the staff is helpful, and the food is great. They even serve wine! One thing that is very different from the US is that the hospitals have a "hotel service" who takes care of meals, leaving the nurses to just care for the patients. We pay a good amount per month (around 600 swiss francs/month/each), but everything is covered except for a 500 franc deductible. As we contemplate retirement, we're seriously considering staying in Switzerland, even though family and friends are in the US, simply b/c of the health care system.
17
Sounds to me like you're insurance level is "private". With "Basic" you don't get hotel service...
2
In Canada, healthcare is provided at the Provincial level - the Federal government contributes to it financially ONLY.
I can't speak for other Provinces, but in Ontario the government health insurance plan (OHIP) DOES pay for basic prescription drugs and eye care, with enhanced benefits to seniors.
The push now is to extend that to include dental care.
The situation is different in other Provinces - and the most 'socialised' is British Columbia, where the NDP (a Social Democratic) party has been in power for most of the time since WWII (BC also has government insurance for motor vehicles, with subsidised premiums)
I can't speak for other Provinces, but in Ontario the government health insurance plan (OHIP) DOES pay for basic prescription drugs and eye care, with enhanced benefits to seniors.
The push now is to extend that to include dental care.
The situation is different in other Provinces - and the most 'socialised' is British Columbia, where the NDP (a Social Democratic) party has been in power for most of the time since WWII (BC also has government insurance for motor vehicles, with subsidised premiums)
5
The NDP has only been in power in BC for about 13-14 years since WWII. 'Conservative' parties have been in power for the rest.
1
A minor correction: the NDP has been running BC for about a month. For well over a decade prior it was the BC Liberals (which is not the same party as the federal Liberals).
I am an American who lived in Britain for 5 years. We had 2 babies there. Healthcare was easier to access, and I was very happy with the quality. Leaving the NHS and returning to the US's broken system weighed on us as we decided whether to move home, and even though we have "good" insurance here, it is unnecessarily complex and difficult to use. I don't think Americans understand just how simple it is to use the NHS. No networks. No claims. No sitting on hold with insurance trying to get them to pay up. We chose between several GP practices and registered by showing our IDs and a utility bill. Taxes go in; appropriate, thoughtful care comes out. Efficiencies are made - vaccines are given by nurses during vaccine clinic hours; recurring prescriptions can be had by emailing in a request rather than wasting a doctor's time; birth control is free and a biannual blood pressure check is all that's needed; well-child checks are done by nurses who are specially trained and will refer to a doctor if needed. Choices abound in childbirth in terms of pain management. The British system is excellent and something we should aspire to emulate.
71
Why are all your panel members men, New York Times?
47
Although the match based knockout structure is familiar because of its sporting ties this really isn't the best way to compare health systems. As one reader already notes it is is also important to take into the account the social expectations and societal structure: viz: Switzerland has a very much more homogeneous population and is small enough to effectively regulate an insurance industry easily. Singapore is such a small and heavily regulated society it shouldn't be here at all except for ideas.
I would be picking the best features from the large European societies.
Of note, a massive disadvantage for Canada that it does not allow private medical care . this would be a non- starter for the US.
The UK or the German systems get my vote .
I would be picking the best features from the large European societies.
Of note, a massive disadvantage for Canada that it does not allow private medical care . this would be a non- starter for the US.
The UK or the German systems get my vote .
3
Most of this is a health payment comparison. In actual care the US system is superior, people come here from around the world for care. We have some of the best and most innovative care in the world. The US wins the care comparison. If you are talking about access and payments we will never be able to compare with others since we are a capitalistic country where profit and large salaries are the goals for many. And most of our country would not like so many immigrant doctors as say England has, nor paying various employees as little as some of these do.
2
Nope. Every single survey of patient outcomes, public health, and longevity puts us just below Cuba.
At best.
Our care ain't that great, okay?
At best.
Our care ain't that great, okay?
2
Health outcomes for the US system are low to middling, the US ranks high in infant and maternity fatalities and low in longevity. Of the world GDP more than 3.5 of world GDP, that is GDP generated by every body in the world is used to finance the mediocre American Health system. What you say about US excellence can be found in many countries for less cost if you have the money and are willing to pay for it.
7
Sorry - but if you look at many measures of health outcomes, the US lags far behind. Life expectancy here in the US is lower than other advanced industrialized nations, and we are the only place where illness is a major cause of bankruptcy (this simply does not happen in other countries). Look at the data, it is widely available from Professor Google. For example, The Commonwealth Fund's 2014 comparison of health outcomes among 11 advanced countries such as UK, France, and USA, ranked the United States LAST compared to the others. True, sometimes very wealthy people come here for some specialized treatment, but guess what? Many countries welcome medical tourists and many American citizens go to other countries for care because they can't afford it here and it is just as good elsewhere. I am happy to have a dentist in Mexico where I get quality care at one tenth the cost I would pay in the US.
4
I note that the criteria for judgment did not include the extent of "fraud and abuse" within each of the systems. If included, I suspect the expert judges might alter their views. The US Medicare program is effectively managed by private insurance fiscal intermediaries with no incentive to control costs, unlike the incentive they have for doing so for their non-Medicare clientele. Further, the pharmaceutical and medical device industry through lobbying and deals cut with medical practitioners exert undue influence on the treatment that patients receive. See: Engelbert J, Parsons, CA, Tefft N. Financial Conflicts of Interest in Medicine (January 26, 2014). Available at SSRN: https://ssrn.com/abstract=2297094, http://dx.doi.org/10.2139/ssrn.2297094, or http://rady.ucsd.edu/faculty/directory/engelberg/pub/portfolios/DOCTORS.pdf
6
The commenter above who adds the PSYCHOLOGICAL cost has it dead right. This is such a key fact that everyone ignores - that in America, we're all being terrorized by our healthcare system.
Unless you're rich, you're always going to approach ANY medical intervention with fear - that you may be gouged, that your coverage doesn't actually cover X or Y, that there's some loophole, that there might be a mistake and that you'll have to wrangle with your insurance company for months before getting reimbursed. Forget about major procedures - you have no idea how many tens of thousands of dollars you may owe afterwards. It takes exhaustive research in advance to get any idea of what's coming, in terms of costs - and even then you can't be sure that some indifferent insurance rep on the phone will simply announce that 'that whoever told you that was wrong' and there's no recourse except months more of fighting.
Or you'll somehow be caught off guard, in the wrong place at the wrong time, with the wrong emergency, like the commenter here who needed a certain medication that costs 5 pounds in England, and $1000 here. All because some sociopathic boy wonder has decided to screw over thousands of people. No protection against criminal corporate greed - this has become a fact of life.
Add the the terrorizing worry that whatever insurance rate you have this year will skyrocket next year. How little insurance will you be able to afford, for how long? How do you quantify all this fear?
Unless you're rich, you're always going to approach ANY medical intervention with fear - that you may be gouged, that your coverage doesn't actually cover X or Y, that there's some loophole, that there might be a mistake and that you'll have to wrangle with your insurance company for months before getting reimbursed. Forget about major procedures - you have no idea how many tens of thousands of dollars you may owe afterwards. It takes exhaustive research in advance to get any idea of what's coming, in terms of costs - and even then you can't be sure that some indifferent insurance rep on the phone will simply announce that 'that whoever told you that was wrong' and there's no recourse except months more of fighting.
Or you'll somehow be caught off guard, in the wrong place at the wrong time, with the wrong emergency, like the commenter here who needed a certain medication that costs 5 pounds in England, and $1000 here. All because some sociopathic boy wonder has decided to screw over thousands of people. No protection against criminal corporate greed - this has become a fact of life.
Add the the terrorizing worry that whatever insurance rate you have this year will skyrocket next year. How little insurance will you be able to afford, for how long? How do you quantify all this fear?
97
And it's all potentially more expensive in the long run. I had a cardiac event this winter. The cardiologist recommends a stress test. But her fee alone was $450 and that was the last of my heath dollars. I can't have the test until I save up for it, even though diagnostically it might reveal things that are better to know in the long and short run. So dumb.
2
I lived in Barcelona, Spain for two years in 2010-12 as an illegal alien (having overstayed my tourist visa limits imposed by the Schengen Treaty). I was living on funds brought into the country monthly from the US as I was not permitted to work.
I was over 60 and I received Cat Salut, the National Health Care System available to all. Since I was over 60, there was no monthly premium.
When I signed up (with the help of a Spanish speaker) it was maybe two pages in Spanish and one signature line. I showed my passport but no one cared if I had a visa or not.
With just my membership card, I could see an English speaking doctor in a local clinic within a few days of a phone request.
As I cancer survivor, I needed annual CAT scans. Waiting time for the CAT scan was about 30 days. The equipment looked similar to what I had experienced in the United States.
My prescriptions were able to be filled at any pharmacy for about 6€ for the three different drugs I was taking. Much less than in the US.
I ended up needing surgery. Waited 60 days. In the hospital for two nights. Lousy food of course. No wheelchair to the front door. on discharge. No one needed to pick me up. I took the bus home.
Total cost was zero.
I now have Kaiser in the US with Medicare Senior Advantage. $200 a month plus co-pays with every visit. I tried Blue Cross but it was terrible. Too much paperwork, facilities spread out all over the place.
I'd take the Spanish system over the US one any day.
I was over 60 and I received Cat Salut, the National Health Care System available to all. Since I was over 60, there was no monthly premium.
When I signed up (with the help of a Spanish speaker) it was maybe two pages in Spanish and one signature line. I showed my passport but no one cared if I had a visa or not.
With just my membership card, I could see an English speaking doctor in a local clinic within a few days of a phone request.
As I cancer survivor, I needed annual CAT scans. Waiting time for the CAT scan was about 30 days. The equipment looked similar to what I had experienced in the United States.
My prescriptions were able to be filled at any pharmacy for about 6€ for the three different drugs I was taking. Much less than in the US.
I ended up needing surgery. Waited 60 days. In the hospital for two nights. Lousy food of course. No wheelchair to the front door. on discharge. No one needed to pick me up. I took the bus home.
Total cost was zero.
I now have Kaiser in the US with Medicare Senior Advantage. $200 a month plus co-pays with every visit. I tried Blue Cross but it was terrible. Too much paperwork, facilities spread out all over the place.
I'd take the Spanish system over the US one any day.
12
Ridiculous. Anything is better than Health Care Inc. in the U.S.
9
I was glad to see this article, but still couldn't help but notice that political considerations entered into the votes of some of the panelists, as other commenters have noted. The NYT still can't seem to let the idea of triangulation go; it still wants to tell us what is good for us while looking over its shoulder at the Republican congress and those poor Democratic politicians who might face (horrors!) the "litmus test" of actually wanting to make health care affordable and accessible.
3
I am an American who has lived in Britain for 30 years where the system was universal and free. I really only experienced it through childbirth X3 and it was fine for that, but I know that there are long waits to see specialists and for operations, which can be cancelled at short notice.
Now I have retired to France where I find the system to be infinitely better. Everyone is covered up to 70% of their health care costs. People below a certain income, children and people with serious illnesses are covered completely and the rest of us take out a small top up insurance to pay the additional 30%. This costs 50 euros each per month. We are immediately referred to specialists if necessary and are carefully screened on a regular basis for just about everything. It is heartbreaking to me that infant mortality rates in some American southern states are worse than a third world country. It is just so wrong that the richest country in the world allows this to happen.
Now I have retired to France where I find the system to be infinitely better. Everyone is covered up to 70% of their health care costs. People below a certain income, children and people with serious illnesses are covered completely and the rest of us take out a small top up insurance to pay the additional 30%. This costs 50 euros each per month. We are immediately referred to specialists if necessary and are carefully screened on a regular basis for just about everything. It is heartbreaking to me that infant mortality rates in some American southern states are worse than a third world country. It is just so wrong that the richest country in the world allows this to happen.
10
My wife and I between us have first hand experience of using the UK's NHS, Australia's Medicare plus very expensive dentistry not covered by Medicare, doctors and therapists in Spain, France, Italy and NZ. My son and grandson have extensive experience of the German system.
On paper, the best value national system of universal sickness seems to me to be Taiwan's, which I've never used:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960712/
On paper, the best value national system of universal sickness seems to me to be Taiwan's, which I've never used:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960712/
1
Meant to write '... universal sickness care...'
1
How much of medical research and development is driven by the (relatively) high rate of corporate income tax? In the unlikely event U.S. federal tax drops to 15%, will this R&D work move out of the U.S. to other higher-tax countries?
I have experienced the US and Danish healthcare systems and prefer the Danish. The pros are no money ever changes hands between patient and provider, high quality of care, coverage not dependent on employment leading to a high level of contentment, less stress and anxiety. The per capita cost is about half of the US, yet health of population is higher. The Swedish and Norwegian systems are very similar and, combined, cover roughly 20 million people.
5
But are not the Danes taxed at 90%
5
5
1
Bonnie: not 90%, LOL, but Danish income taxes are 61% for most middle class people (and they have almost NO poor people)...it is a nation of only 5 million, almost all white and ethnically very similar. It is easy to get people to vote for benefits that accrue to themselves an people JUST LIKE themselves.
The Danes also pay 25% VAT on every single purchase...except cars. The tax on an automobile in Denmark is 180% -- so a little subcompact costs about $70,000 or more (US).
While I think Denmark is a fine place....how do you "scale this up" to a country as huge and diverse as the US?
Can you really "sell" American taxpayers on a 61% income tax? triple the current rates? PLUS a 25% VAT on every purchase? and if not -- how will you pay for all this?
The Danes also pay 25% VAT on every single purchase...except cars. The tax on an automobile in Denmark is 180% -- so a little subcompact costs about $70,000 or more (US).
While I think Denmark is a fine place....how do you "scale this up" to a country as huge and diverse as the US?
Can you really "sell" American taxpayers on a 61% income tax? triple the current rates? PLUS a 25% VAT on every purchase? and if not -- how will you pay for all this?
1
Our country is severlly handicapped by its health system.
According to CIA 2016 data US life expectancy ranks a disgusting 43rd in the world. The average health cost of the 42 countries with better life expectancy is $4,490 per person per year yet we in the US are charged $9,892 per year. A stunning $5,402 person per year of excess charges and we are living less years of life.
According to CIA 2016 data US life expectancy ranks a disgusting 43rd in the world. The average health cost of the 42 countries with better life expectancy is $4,490 per person per year yet we in the US are charged $9,892 per year. A stunning $5,402 person per year of excess charges and we are living less years of life.
7
come now the health care system has little to nothing to do with say murders in Chicago, drug use around the country, or obesity. And we pay our people more than most other countries as well.
2
vulcanlex--so you're bragging the usa would be higher if not out for mindless violence, lack of sane gun control, morbid obesity/lack of proper eating habits and self control......and where does the usa rank in family income? i think its up there in household debt, isn't it?
3
Our medical system puts us at huge competitive disatvantage to the rest of the world. For example our competitors like Europe is 10.0% of GNP, Canada 10.4%, China 5.5% yet those countries have longer life expectancy and EVERYBODY is covered. Our medical is over 17% of GNP and we still have people missing out. Plus a healthy workforce is more competitive.
1
I just know the Canadian system but I still voted
Canada
Canada
1
The U.S won't even come in Third. We have some of the best medical technology in the world, but the service is less than prime. We can thank the politicians and the mega corporations for that....
3
I live in France. I am astounded that Ashish commented "However, the U.S. delivers a superior quality of care on the measures that matter most to patients." What measures would those be, if not rapid and free access to excellent care? French medical practice and hospitals are cutting-edge. It would be beyond unthinkable for person in France to go bankrupt due to medical costs, or to be thrown out on the street after major surgery for lack of insurance, or to bring a child into a hospital emergency room and be greeted by a nurse asking for hundreds of dollars in payments before even looking at the patient, all common events in the US. Another striking difference is that certain medical procedures are accompanied by many less invasive, expensive and seemingly unnecessary extra tests and visits in France than the same procedures in America. This is partly due to the influence of the religious right (unnecessary preparations for abortion), partly because the American medical establishment wants to get rich, and partly to doctors' terror of lawsuits, a feature which doesn't exist anywhere else and should have been a consideration in your discussions of the American healthcare system.
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Perhaps your idea of cutting edge is somewhat different than others? The French plan is great for the French population, not so successful if you had our population. Good point that our costs are higher due to defensive medicine and various lawsuits.
1
vulcanalex...your responses are so weak that i'm not sure why you bother. how do you know the writer isn't american? longer life expectancy, cheaper cost and the horror of living in france are terrible things?
6
Hello Leila,
I have a similar experience of the French healthcare system - from my time as a student in France between 2007 and 2010. I have absolutely zero complaints. In winter I needed minor surgery on a bleeding nose, it was done for me FREE OF CHARGE at a local health centre, within 10 days of the doctor's advice. Similarly I received all vaccinations for free, as required.
It seems to me that a lot of people who haven't experienced France from the inside seem keen to make French healthcare look worse than it really is by inventing flaws that matter very little. I also recall a family member of mine who was living in the UK and told me of shocking waiting times to see a GP in London - never happened to me in France.
I find the NYT's panel to be very narrow, totally devoid of end users' perspectives on the different healthcare options. Hence we are given a glowing assessment of US healthcare based on seemingly "technical" considerations.
But what is the worth of such cutting-edge stuff if it is only available to a minority?
I have a similar experience of the French healthcare system - from my time as a student in France between 2007 and 2010. I have absolutely zero complaints. In winter I needed minor surgery on a bleeding nose, it was done for me FREE OF CHARGE at a local health centre, within 10 days of the doctor's advice. Similarly I received all vaccinations for free, as required.
It seems to me that a lot of people who haven't experienced France from the inside seem keen to make French healthcare look worse than it really is by inventing flaws that matter very little. I also recall a family member of mine who was living in the UK and told me of shocking waiting times to see a GP in London - never happened to me in France.
I find the NYT's panel to be very narrow, totally devoid of end users' perspectives on the different healthcare options. Hence we are given a glowing assessment of US healthcare based on seemingly "technical" considerations.
But what is the worth of such cutting-edge stuff if it is only available to a minority?
Health Care is expensive here, but you get what you pay for. Scheduling is easy, and doctors deliver care with a personal touch, without trying to up sell higher margin services and products that goes into their pocket. I'm a satisfied customer
2
I live in switzerland and I know how the France systme works through many discussions with French peiople.
Our systme is on the whole better, especially in matter of quick availability for specialists in France, it may takes up to 6 months to see an ophtalmologist...). Here it'll take less than a week and you always have possibilities to show in a special clinic and just wait for your turn.
BUT our system is a lot more expensive...the average monthly insurance coverage amounts to 350-450 CHF (about the same in US$) as the average imonthly income is a bit over 6'000 CHF. So we pay arounf 8-10% of our income for basis insurance....But we get very good quality in return.
Our systme is on the whole better, especially in matter of quick availability for specialists in France, it may takes up to 6 months to see an ophtalmologist...). Here it'll take less than a week and you always have possibilities to show in a special clinic and just wait for your turn.
BUT our system is a lot more expensive...the average monthly insurance coverage amounts to 350-450 CHF (about the same in US$) as the average imonthly income is a bit over 6'000 CHF. So we pay arounf 8-10% of our income for basis insurance....But we get very good quality in return.
6
I agree these are all superior to our system. It's interesting that some systems use mandatory savings accounts. In the discussions prior to instituting our Social Security, conservatives in Congress refused individual savings accounts in favor of a tax paid into the general fund. As a result our Social Security benefits are in danger because administrations have taken these funds for other purposes.
In the beginning this was called "borrowing." But G W Bush announced that these borrowings would not be paid back.
We must change our representation in Congress to ever hope for universal health coverage.
In the beginning this was called "borrowing." But G W Bush announced that these borrowings would not be paid back.
We must change our representation in Congress to ever hope for universal health coverage.
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Which won't be happening any time soon. How about we just allow states to do what they want and are willing to pay for? And it is mostly how we pay for the care.
1
States are historically bad with that kind of responsibility. they don't have the resources cash or otherwise,even if they had the will to manage health care. You could live in one state with no coverage, while the state next door has it.
4
Funny that I should read this about the Australian system. Was speaking with a GP in Australia the other day and he was complaining loudly about the care he has to give now as opposed to "the older days". I would suspect he was in his early 70's and still working. He told me that he was limited by his government to spend no more than 8 minutes per patient. that was what he was allotted, and actually what time he spent with the patient was limited by his ability to type his notes which was apparently within the scope of 8 minutes. I have never heard this before but it got me wondering. Can you really expect an American to see his doctor for only a few minutes?
2
As an Australian (currently living in Finland) I know this is nonsense. No GP or specialist has ever said such a thing to me and last time I say a GP I was there for half an hour for a cancer check. Completely free because it was covered by the Medicare payment system. The same with the last visit I made to a specialist. Some of the 'expert' advice about Australia was misleading and ignorant of the medicare and bulk billing system. Half of people pay nothing for medical service. All must pay the central medical insurance payment. The quality of service is higher than Finland, which prides itself on efficiency and low cost but at the price of humanity and waiting times. I have also experienced the French system and it really is excellent and humane although insurance is higher.
4
Canada has universal coverage and the patient has absolute choice in primary care physician and specialists with zero direct charges for hospital care. Doctor fees are creeping in.
Canada excludes many aspects of care from coverage including dental, drugs, optical, physiotherapy so barriers to care for the poorest are significants and patients often can't afford the drugs prescribed and the poor commonly have multiple missing teeth.
Canada excludes many aspects of care from coverage including dental, drugs, optical, physiotherapy so barriers to care for the poorest are significants and patients often can't afford the drugs prescribed and the poor commonly have multiple missing teeth.
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Thanks for mentioning that. Most Americans have fantasy beliefs about "Canadian Single Payer" that are absurd -- that it costs nothing -- that no taxes or VAT are involved -- that EVERY procedure you might want is 100% free -- that drugs, dental, vision care are all 100% -- including cosmetic procedures.
Look at how adding Part D to Medicare has delivered crushing costs with NO increase in taxes or income -- a time bomb that won't fully detonate until boomers are all on Medicare in a few years.....
Look at how adding Part D to Medicare has delivered crushing costs with NO increase in taxes or income -- a time bomb that won't fully detonate until boomers are all on Medicare in a few years.....
2
It's interesting to me that looking at the reader choices, the trend is toward wanting simpler, more guaranteed coverage. For example, the majority picked France over Switzerland despite the choice of the judges. I'm suspicious of the Switzerland conclusion of better outcomes because the Swiss have a much smaller, much more homogeneous population. I wonder what the average income is in Switzerland and if they have the extremes of wealth and poverty that we have.
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I choose Germany or France. Both better plans than the cheaper UK; all much better than US medical care Non-System.
Why not look at México, or Spain ?
2
I lived all of these countries and xvept singapore and Australia. I found U.K. The best
Should have been a repeat with initial bracket matches shuffled again.
I'll take the Swedish one over all others. Health care will cost no more than around 300 US dollars for a 12 month period. Same for prescription drugs. A visit to a hospital emergency care, to a specialist, a heart operation, to get a cold medicine prescription, they all cost around 30 US, and you pay up to about 300, after that everything is free, no health insurance payment. Who cares if sometimes you wait a couple of hours at the emergency room. Sweden pays for it with high taxes to the top earners, and the lowest tax bracket is about 30 %, but the peace of mine is priceless.
28
Yes but what are the costs, and your population is not ours.
2
It is pretty easy to offer good health care to only 9 million people, all of whom are white, middle class, ethnically/culturally identical.
Let's see you scale it up to 330 million DIVERSE people, including a huge underclass of very poor minorities.
If Sweden had to deal with that (or Canada for that matter)...their systems would collapse entirely within six months.
Let's see you scale it up to 330 million DIVERSE people, including a huge underclass of very poor minorities.
If Sweden had to deal with that (or Canada for that matter)...their systems would collapse entirely within six months.
Which one would I pick? ALL or any of them. They are all superior to what we've got going here.
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My family and I have had healthcare in Australia, England, Canada and the US. I would rank them 9, 8, 6 and 1 in that order. We have so few excuses when we should be such a rich country, with such great doctors and equipment. Our system stinks because our lobbies have so much power. A Bloomberg survey just ranked us 46 / 48 for healthcare efficiency. My overseas friends are so proud and happy with their advanced, preventative, much less expensive healthcare for everyone! We should be ashamed!
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I think you mean "rate" them. Not "rank" them. If you really mean "rank" them, then you've ranked the U.S. as #1 (best) healthcare system. But you clearly mean the opposite based on everything else you said in your post.
Just a little statistical literacy helps :-)
Just a little statistical literacy helps :-)
1
I found myself asked my more specific questions than the attributes covered in the comparisons. What specific procedures ( e.g. Transplants) are covered and to what age or how many times? What specific medications are/are not covered and what are the age/time limits? What are the major health drivers of the health profile of that country (e.g. Obesity, smoking, environmental, activities, etc).
A nice start to the discussion. More nuance needed.
A nice start to the discussion. More nuance needed.
2
I have experienced the health systems in England, the Netherlands, France, Austria, Germany and Canada. My preference is for the German or Netherlands or French systems.
I wrote on this topic many years ago. http://jamanetwork.com/journals/jama/article-abstract/385931
I wrote on this topic many years ago. http://jamanetwork.com/journals/jama/article-abstract/385931
1
Although this is an interesting exercise, it might be more productive to look at these systems from the perspective of the major problems that we have and what features of other systems might ameliorate them.
The uninsured: Make enrollment automatic. A mandate falls short because of compliance problems.
The underinsured: Reduce cost sharing to levels that will not create financial barriers to care.
High costs: Publicly-administered pricing comes closest to getting it right - legitimate costs plus fair margins.
Lack of choice of physicians and hospitals: Do not create artificial panels that serve third party payers at the cost of patient choice.
Impaired access to specialized services: Do not segregate low-income individuals into chronically underfunded welfare programs.
Profound administrative waste: Hundreds of billions of dollars could be recovered with a much more efficient financing system.
Now look again at how the various systems address these issues. Oops. There is not enough information here since the field of health policy is so much more complex than can be boiled down to simple comparisons. But when you add the other features that cannot be included here, you would end up with a single, equitably-financed, publicly-administered program - not an exact duplicate of any of the nations listed. That could be accomplished by improving our Medicare program and expanding it to include everyone.
The uninsured: Make enrollment automatic. A mandate falls short because of compliance problems.
The underinsured: Reduce cost sharing to levels that will not create financial barriers to care.
High costs: Publicly-administered pricing comes closest to getting it right - legitimate costs plus fair margins.
Lack of choice of physicians and hospitals: Do not create artificial panels that serve third party payers at the cost of patient choice.
Impaired access to specialized services: Do not segregate low-income individuals into chronically underfunded welfare programs.
Profound administrative waste: Hundreds of billions of dollars could be recovered with a much more efficient financing system.
Now look again at how the various systems address these issues. Oops. There is not enough information here since the field of health policy is so much more complex than can be boiled down to simple comparisons. But when you add the other features that cannot be included here, you would end up with a single, equitably-financed, publicly-administered program - not an exact duplicate of any of the nations listed. That could be accomplished by improving our Medicare program and expanding it to include everyone.
45
I've used the NHS in UK and various universal health care systems in different countries in Africa. The NHS worked well for emergency care, though optional service (e.g., hernia) might take more time. It was truly universal, and involved essentially no paperwork, no co-pays, no insurance companies, no time or paper-chasing.
14
The best health care system is one that no country has now and that no one has proposed. Private insurance companies have failed to provide a satisfactory solution. All forms of government insurance are risky because conservatives have and will continue to seek coverage limitations and benefit reductions.
Mutual life insurance policies generally have lower premiums than policies issued by corporate insurance companies. Credit unions and mutual savings banks generally provide better services than corporate banks. The best health care system would be one provided by a mutual health insurance company owned by its policyholders.
Mutual life insurance policies generally have lower premiums than policies issued by corporate insurance companies. Credit unions and mutual savings banks generally provide better services than corporate banks. The best health care system would be one provided by a mutual health insurance company owned by its policyholders.
1
We've failed to address the larger question here. When I'm up against a deadly whatever, I don't care what it costs to fix the problem. I bet you don't either. We already have quater-million-annually gene thearapies. Like it or not, we need to look 'death panels' in the face. Unless we put limits in place, unbridled innovation will be ruinously expensive, and ultimately reserved for the very rich. I vote for an absolute limit on the cost of any drug or device. Just tell the innovators: if it's going to cost more than X, don't bother going there. Dying may be old fashioned, but it's not going away. The money would be much better spent feeding the millions dying of hunger. As a drug, food is a much better value.
30
The Innovations have never been the problem, it has always been the unlimited ability to gouge US. Whether it is just under $500k for a round of the newest gene based cancer therapy or $80k for 90 tabs of Hep-C treatment that runs about $1 a tab to make and the manufacturer sells for around $800 for 90 tabs in Egypt.
One proposed solution is for moon-shot style contests with prizes of $10b, $2b, $1b, $500m, $200m for development of new treatments matched with 4x the difference liability for any manufacturer that sells treatments for higher prices to us than they do to any of the other G20 democracies.
One proposed solution is for moon-shot style contests with prizes of $10b, $2b, $1b, $500m, $200m for development of new treatments matched with 4x the difference liability for any manufacturer that sells treatments for higher prices to us than they do to any of the other G20 democracies.
Yes most don't care, I act as if the money was mine, since it really is.
1
What's more the US arguably doesn't even benefit from innovating for the world. Harvoni, Gilead's Hepatitis C cure, costs $1300 in Egypt but $95,000 in the US. One result is that Hep C continues to rage in the US. In Egypt, Hep C is coming under control.
If our own citizens can't benefit from innovation, who is? Well that would be the CEO and shareholders of Gilead and Hep C sufferers elsewhere in the world. This is wrong, just plain wrong.
If our own citizens can't benefit from innovation, who is? Well that would be the CEO and shareholders of Gilead and Hep C sufferers elsewhere in the world. This is wrong, just plain wrong.
3
Beautiful job of outlining these different systems, especilly given the American left's insistence on believing that everybody else has a simple single-payer system.
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robert,...the point is that these systems all seem to work better than the american system with lower costs. not too many americans commenting in this space who've lived or experienced other countries' systems think they're worst than the usa.
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Robert - By at least two criteria, every single one of these systems outperforms the U.S. system. The first is that all citizens are covered and, in some countries, even non-citizens are included. Second, there is no such thing as medical bankruptcy in any of those other countries.
5
Neither of the responders paid any attention to what I said.
The difficulty for a US transition to any of the discussed healthcare systems is the "art of the deal" (hahahahaaaa!!!). It is with this consideration in mind that the discussion would have benefited from elaborating on how each system got to where they are today, which in most cases is a patchwork of private insurance or nothing in post-war Germany.
The example of Canada is perhaps the most instructive in this regard. Prior to the current system described in the article, the Canadian system was virtually identical to that found in the US pre-LBJ. Thus, "Taxpayer-funded medicare in Canada did not appear at a single point in time: it emerged over a quarter century from 1962, when physician services were covered across Saskatchewan, to 1987, when the demise of optional “full billing” in Ontario began."
This is a partial explanation of why coverage in Canada is still limited to "medical" only and not dental nor prescriptions. It is important to note that it is only for these non provincially covered domains that health insurance may be purchased. There is no allowance for any duplicate,competing private systems in the Canadian model, which must be a bedrock principle as the US moves forward.
The example of Canada is perhaps the most instructive in this regard. Prior to the current system described in the article, the Canadian system was virtually identical to that found in the US pre-LBJ. Thus, "Taxpayer-funded medicare in Canada did not appear at a single point in time: it emerged over a quarter century from 1962, when physician services were covered across Saskatchewan, to 1987, when the demise of optional “full billing” in Ontario began."
This is a partial explanation of why coverage in Canada is still limited to "medical" only and not dental nor prescriptions. It is important to note that it is only for these non provincially covered domains that health insurance may be purchased. There is no allowance for any duplicate,competing private systems in the Canadian model, which must be a bedrock principle as the US moves forward.
3
If you read this excellent survey, you will find that private insurers supplement every aspect of Canadian health care, beginning with the prescription, dental and optometry that Canadian health doesn't generally provide.
5
@Robert - my comment delineates what private insurance may offer, e.g., dental, cosmetic, unapproved treatments and pharmacy. The point is that you cannot buy coverage that equates to the provincial plans, and that exists to avoid a two-tier system.
3
I see your point, but yeah, you actually can. If you've got the dough, which few would.
1
We lived in Toronto for seven years in the 1980s. Our access to care was excellent, including nearly free surgery to repair a pre-existing high school injury. To me, what is remarkable is and was the almost universal belief in the goodness of the provincial health system. The attitudes toward health care between our Canadian and American friends was startling different both then and now.
Can the Canadian system be improved? Sure. Is it better than my Medicare-based American system? Yes, I think so.
Can the Canadian system be improved? Sure. Is it better than my Medicare-based American system? Yes, I think so.
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Whenever I visit Canada, I notice everyone seems more content and overall healthier. There's the psychological safety net here too, knowing you will be cared for if necessary. We in the US are ALWAYS worried about the smallest medical problem and often skip out on getting care due to the related costs.
Nobody can afford to get sick or injured. Medical bankruptcy constantly hangs over us. It messes us up in more than one way.
Nobody can afford to get sick or injured. Medical bankruptcy constantly hangs over us. It messes us up in more than one way.
163
I think you've hit the nail on the head.
We don't worry about illness or medical coverage, because we're covered.
My daughter has been in the hospital for over 3 months with a couple of emergency surgeries, we've paid for parking and coffee out of pocket. No worries about what wasn't covered, which is great because at times like those you have enough other things to worry about.
We don't worry about illness or medical coverage, because we're covered.
My daughter has been in the hospital for over 3 months with a couple of emergency surgeries, we've paid for parking and coffee out of pocket. No worries about what wasn't covered, which is great because at times like those you have enough other things to worry about.
24
I'm stunned that the US is even ranked in this survey. Some 28 million not even covered, and likely to rise if the Republicans have their way. And then there is the matter of outrageous costs. Like I say - stunned.
16
"Let's play" indeed! -- one looks to The Upshot for analysis, not games. An analysis we would rather see is a quantitative comparison of national universal health systems by outcome, access, percent of GDP, private vs public insurance and doctor fees. Nations that should be considered in a blueprint for a redesign of the system for the United States should include France, Canada, Britain, Germany, Norway, Sweden, Denmark, Netherlands, Finland, Japan, and Australia. Bias based on competitiveness, innovation, moral aspects of government involvement should not be considered.
10
Read the Commonwealth Fund's International Health Care System Comparison 2017
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
It has most of what you are looking for and people need to make a proper comparison.
http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirro...
It has most of what you are looking for and people need to make a proper comparison.
Discounts are the primary difference between a good system and a bad one. In France discounts are prohibited and medical providers compete with rates for services that must be posted. Patients know in advance what their insurance policy will reimburse and the difference is what will be paid out of pocket. In the U.S., insurance companies control the business of medicine by negotiating discounts with providers in exchange for in-network status. Patients get lower costs by going to providers approved by their insurance company. This reduces patient choice and greatly inflates the fees for those with the wrong insurance or no insurance. Imagine what would happen to drug prices if anyone and everyone would be charged the same unit price with no discount.
The great potential of the U.S. comes from the 50 states. Each state should have the opportunity to develop and implement its own health care system, just like the states did with automobile insurance. Over time, the better systems and procedures will expand to other states. The block grant approach now being contemplated in the U.S. Senate may be the best way to go the grand experiment. Diversity will help make America great again.
The great potential of the U.S. comes from the 50 states. Each state should have the opportunity to develop and implement its own health care system, just like the states did with automobile insurance. Over time, the better systems and procedures will expand to other states. The block grant approach now being contemplated in the U.S. Senate may be the best way to go the grand experiment. Diversity will help make America great again.
4
Minor technical detail: in France, the prices for services and for prescriptions are set by the national government on the basis of negotiations carried out yearly.
It is also worth noting that the "diversity," you demand has left us with grossly inequitable pricings, especially in rural areas, that have nothing to do with actual costs.
It is also worth noting that the "diversity," you demand has left us with grossly inequitable pricings, especially in rural areas, that have nothing to do with actual costs.
11
Rural areas need rural solutions that might include attracting health care professionals and using technology to deliver services. The state officials know what is required, not Washington DC
2
eugene....each of canada's 10 provinces controls its own health care system. the federal government helps to fund it, but the percentage has dipped over time.
1
As a student in Paris back in the '70's, I had an operation and five-day stay in the American Hospital of Paris for a serious condition I had suffered all my 20 years in the Southern US, for want of funds. My costs were exactly zero; in exchange, I was asked to sign an agreement to the effect that I would make good "someday". Of course, I have helped out the American Hospital from time to time, and have included them in my will. France's system delivered me from pain and disfigurement. Compassion is the difference between the US system and those of the rest of the world.
132
I am not sure the solidarity effect is appreciated by those who have not experienced it. Living in Germany, it was considered important that everyone have healthcare and that all contribute to their care, in an economically feasible way. It helps hold a nation together positively.
3
This reads like a charity care case, and not under the normal system? No?
It's time to ask which system is better at providing preventive care, such as smoking prevention/cessation, healthy eating, clean air & water, safety, etc. Which country puts a fence at the top of the hill rather than an ambulance at the bottom? To me, US too obsessed with interfering in free market that excels at providing care after-the-fact rather then preventing health problems.
3
Drawing parallels between ACA and the Swiss system is liking saying that a horse is similar to a donkey. True, but that misses the entire point of what they were built for. Unless the ACA includes a mandate for government cost-controls like negotiating rates and setting fee structures for providers and drugs, makes all the current insurance companies non-profits and mandates trimming down the number of plans made available by these private insurers to cut on administrative wastage, the US is going to be lagging behind. I'm even surprised that France vs the US was a 3-2. It should have been a 5-0
98
Having moved from the US to Switzerland, and having experienced hospitals in both countries, it is more and more obvious that the Swiss system is what the ACA should have been. It requires a lot of regulation, but making insurances and hospitals truly non-profit (no hospital waiting room looking fancier than the four season's lobby) is the main step to lower down costs. Also, since insurance is mandatory and this is truly enforced, it can be decoupled from employment. This plus knowing exactly how much your copay will be makes any already stressful medical procedure much easier to handle.
2
I could be out in left field here... but I have to believe Switzerland's approach is largely made possible by a relatively small and high per capita wealth population. Their coverage and access requirements at lower income / higher chronic illness levels have got to be much smaller and less costly aspects than in all other countries and systems considered here.
5
My husband and I have a vacation home in France. I have had a number of
doctor's visits while there. I have always been gratified that the cost of
a doctor's visit is so low ( around 23 euros) and that prices for prescribed
medications are so low. We don't participate in the national system which
would lower our costs even more. Within the last two years I had a sonogram which cost about a tenth of what it would have cost in Atlanta.
doctor's visits while there. I have always been gratified that the cost of
a doctor's visit is so low ( around 23 euros) and that prices for prescribed
medications are so low. We don't participate in the national system which
would lower our costs even more. Within the last two years I had a sonogram which cost about a tenth of what it would have cost in Atlanta.
39
The article omits detailed discussion of quality. Having practiced internal medicine 36 years in Franklin Co., NY near the Canadian border, where people can travel from the U.S. to Canada for lower cost, and from Canada to the U.S. for essential care and medicines not provided north of the border, I have perspective beyond what economists can see.
Mammography equipment in some Canadian provinces, and in Australia and England, remained decades behind what we used, giving poor images and high radiation exposure. "Can't show anything I cannot feel with my fingers" to quote an English physician friend. Same in Australia, where one of my patients, on teaching sabbatical, recognized how obsolete the government clinic mammography was. Repeat imaging at a private clinic revealed the early cancer missed at the government facility.
A physician in Labrador City told me why he was emigrating to the U.S. He was allotted 5 minutes per encounter, only had time to ask if any prescriptions needed refilling before leaving the room. Yes, it was cheap. He received $5.70 (about 5.00 USD) per visit from Canadian medicare.
Highly recommend "The Healing of America", 2009 book by T.R. Reid. Reid would choose the French system. It could be adapted to the U.S., private payers, with government control of fees and government mandate that all providers accept all insurances & elimination of our expensive clerical quagmire in billing.
The model we should copy is from France. By
Mammography equipment in some Canadian provinces, and in Australia and England, remained decades behind what we used, giving poor images and high radiation exposure. "Can't show anything I cannot feel with my fingers" to quote an English physician friend. Same in Australia, where one of my patients, on teaching sabbatical, recognized how obsolete the government clinic mammography was. Repeat imaging at a private clinic revealed the early cancer missed at the government facility.
A physician in Labrador City told me why he was emigrating to the U.S. He was allotted 5 minutes per encounter, only had time to ask if any prescriptions needed refilling before leaving the room. Yes, it was cheap. He received $5.70 (about 5.00 USD) per visit from Canadian medicare.
Highly recommend "The Healing of America", 2009 book by T.R. Reid. Reid would choose the French system. It could be adapted to the U.S., private payers, with government control of fees and government mandate that all providers accept all insurances & elimination of our expensive clerical quagmire in billing.
The model we should copy is from France. By
71
Odd that both Canada and England enjoy generally better treatment outcomes then, isn't it.
51
But, is that even true? Not according to my experience (I have many family members both in France and in the UK). What are the measures being used to make that assessment?
2
Interesting perspective, but you'd think if it was significant it would show up in the outcomes. The Canadian system has comparable or better outcomes than the US.
9
I would genuinely be interested in examples of innovation in medical technology the U.S. provides to citizens around the globe at this point to which Dr. Garthwaite refers. The problem with our system is profit is that our "innovation" is no longer driven by the incentive of making a product that improves people's lives because fraud (think off-label prescribing) and price gouging are easy to get away with. We also invest too much in the idea that we need more technological innovation to improve our health, when what we need is a better organized system with fewer inefficiencies. Ours is so fragmented -- a result of our insurance model and privatized healthcare systems -- that a lot of errors and oversights happen even for people who have insurance because it is hard for doctors to communicate. Plus mental health is so segregated from primary care in most cases. Some systems are trying to innovate by undoing this fragmentation, but is an uphill fight.
21
In Japan the govt sets the fees that hospitals and clinics can charge. It's based on fixed costs and on giving the doctor or clinician a fair salary but not a stupendous one. So professionals in the field of medicine are wellpaid but not hugely wealthy. In fact, they get a very decent salary but they are not buying helicopters and third and fourth homes like in the US.
58
The cost of having "universal health care" are two things that Americans do not wish to pay (besides taxes) -- one is having doctors, nurses and administrators earning the moderate reasonable salaries that such professional earn in Europe or Canada. US doctors especially feel "entitled" to be rich, and earn six figure incomes to "repay them" for a long, demanding education.
The other is illegal immigration. NO country can afford to pay for the health care of 10% of the population of their neighboring country -- we can't have universal health care until all illegals are deported -- yes, including dreamers -- ALL OF THEM. If you want universal health care....that is the price you must pay.
The other is illegal immigration. NO country can afford to pay for the health care of 10% of the population of their neighboring country -- we can't have universal health care until all illegals are deported -- yes, including dreamers -- ALL OF THEM. If you want universal health care....that is the price you must pay.
I've yet to meet a primary care doc or psychiatrist in the US who has a second home off of their own income, let alone a helicopter.
2
My doctors don't make nearly enough money to be buying helicopters! The only doctors in the US who get very rich are surgeons who perform numerous surgeries. They might buy a second home but I have friends earning teacher salaries who can afford that. Anyone who really examines the Explanation of Benefits information will see the huge difference between what the doctors supposedly charge and what the insurance companies actually pay. It's a huge difference. The myth that all doctors are very rich is just that, a myth. A lot of our healthcare dollars are spent on pharmaceuticals and hospital visits.
1
The Times needs to do an analysis based on cost. Compare the taxation rates for US citizens in a "normal" taxed state (not NYC) and compare the costs of the system - how much you pay in taxes if you make $100K in the US vs living in the UK, Switzerland, etc. and compare the salaries of the physicians, the cost of medical devices, nurses' compensation. And I assume that you must be a legal resident in these countries if you live there to receive care? So what happens to the millions of illegal immigrants in the US? No care?
5
In the systems that I know of, non-authorized residents (tourists, illegal immigrants) either pay the full cost of their treatment or are given emergency care only and sent back to their home countries after being stabilized.
I received treatment at full cost for an infected cut while on an extended visit to Japan, and I know people who have suffered broken bones and other injuries in various European and Latin American countries. The emergency rooms in these countries patched them up but didn't do any follow-up care.
I received treatment at full cost for an infected cut while on an extended visit to Japan, and I know people who have suffered broken bones and other injuries in various European and Latin American countries. The emergency rooms in these countries patched them up but didn't do any follow-up care.
4
Amount of GDP spent on healthcare says it all. We pay nearly 4x more than some of the developed nations that cover everyone, twice what Britain spends and half again more than France for a system that fails a huge percentage here and bankrupts so many. None of the other developed nations citizens face bankruptcy just because they have a serious accident or illness.
Medicare for Everyone with negotiated prices and fees would also cost less than what we spend on healthcare now and cover everyone. Single-payer Cuts out a huge amount of the resources and cost of dealing with hundreds or thousands of different insurance companies and plans. We can't afford to go on with unrestrained price gouging. We can't afford to go back to insurance company schemes to inflate their profits at the cost of American lives. We need single-payer now!
Medicare for Everyone with negotiated prices and fees would also cost less than what we spend on healthcare now and cover everyone. Single-payer Cuts out a huge amount of the resources and cost of dealing with hundreds or thousands of different insurance companies and plans. We can't afford to go on with unrestrained price gouging. We can't afford to go back to insurance company schemes to inflate their profits at the cost of American lives. We need single-payer now!
4
We were holidaying in the UK this summer and our daughter, who has kidney stones when all of a sudden had an agonising attack. We rushed her to the nearest hospital where she was attended to almost immediately and what was quite surprising, completely without charge for medicines they administered or the doctors who attended to her. Quite unlike her experiences in America, where she attended university, which were horrifying in both cost and care, (thank god she was comprehensively insured there).
52
My husband and I were visiting Glasgow last summer when he became seriously ill. We were driven to the emergency room at Glasgow Royal Infirmary by a friend where my husband was promptly seen and treated. That visit was free. We insisted on providing our insurance information but the nurses at the admitting desk just smiled and said it wasn't necessary. I'm still amazed by that.
4
Being a full-time American student getting a degree in France, I can 100% say their system is far superior. I pay 250 euros per year, get full coverage, and the costs for my prescriptions are so low I don't even bother to get reimbursed as its not even worth the effort (3euros for a 3 month supply of my medication). For non essential doctors yes, there is a wait, but for essential treatments I've never had to wait. I know students who've had full surgeries here, no problem. Access to healthcare is a big reason why I am deciding to stay here for the rest of my education (not to mention the reasonably priced university fees, also only around 200 euros a year)
183
But surely you know that it cannot actually COST 250 Euros (about $300 US)??? so someone is paying the true cost, just not YOU. The taxpayers of France are subsidizing you, even though you are a foreigner and paying very high taxes to do so. If you STAY in France, and work....you will then pay those very high taxes. Including a VAT on every single purchase.
Yes I am very much aware of that, as everyone else is in France. To be completely honest I am happy to pay higher taxes so that everyone can have better healthcare, simply because I believe that human beings deserve the right to live and be healthy! Today I am benefiting from paying lower prices, because I am a student with no income, and one day when I make money I am more than happy to help fund other people's healthcare, etc. I can't believe some people have such a selfish mindset that they think paying more in taxes is more important than people literally dying from lack of healthcare.
1
CC - Bottom Line.
Cost per person in 2013 in PPP dollars:
US - 8713
France - 4124
1
I think it's simple to see how a Singapore like system could work in America. Rather than mandate the savings, fund it directly.
The way Social Security is funded has proven very effective. There's plenty of reason to believe health savings accounts could be funded the same way. Means based assistance could also be provided to those that need it by removing the income cap that the SS tax currently employs.
I believe a true Medicare for All system is a better solution, but a Hybrid Singapore would be much better than our current mess. A system like this would encourage consumer shopping AND help lower the overall cost of a the solution by protecting the front door with a deductible.
The way Social Security is funded has proven very effective. There's plenty of reason to believe health savings accounts could be funded the same way. Means based assistance could also be provided to those that need it by removing the income cap that the SS tax currently employs.
I believe a true Medicare for All system is a better solution, but a Hybrid Singapore would be much better than our current mess. A system like this would encourage consumer shopping AND help lower the overall cost of a the solution by protecting the front door with a deductible.
2
Something almost never talked about in these types of discussions: outside of the US, patients cannot sue their doctors, and there are no patient satisfaction surveys linked to physician pay. This is worth mentioning, because these are hidden drivers of cost in the American system.
11
Hi, in Canada you certainly can sue your physician.
3
When I was involved in a minor traffic accident while visiting France, not only the police, but also an ambulance arrived on scene. As I complained of my neck, I was immediately placed on a stretcher and taken to a nearby hospital via the ambulance, where I received x-rays and saw a doctor, all within about 2 hours time. The entire cost added up to less than $25 USD. I was not required to provide information on my private insurance - all services were provided for by the nominal fee paid at the hospital. Subsequently, my physical therapy sessions in the U.S. were only partially covered by my employer-provided insurance, which added up to over $800 out-of-pocket.
When my friend (a French citizen) required dialysis at a local hospital, she was picked up & returned to her home by ambulance 3x per week until a kidney transplant could be arranged, which was performed after a 5-month wait. Her out-of-pocket expenses for everything were minimal.
These and other first-hand experiences solidified my belief that the French system "works" for citizens and visitors alike.
When my friend (a French citizen) required dialysis at a local hospital, she was picked up & returned to her home by ambulance 3x per week until a kidney transplant could be arranged, which was performed after a 5-month wait. Her out-of-pocket expenses for everything were minimal.
These and other first-hand experiences solidified my belief that the French system "works" for citizens and visitors alike.
138
Surely you know that a hospital admission, xrays and so forth did not actually cost only $25 -- even if the doctors worked for minimum wage!
The taxpayers of France gave you a "freebie" -- that's all.
Also: something is wrong with your story about the kidney patient. There is a WORLD WIDE shortage of organs, especially kidneys, and a 5 month wait is almost unheard of -- most people wait up to 7 years and about 80% die before getting a kidney.
The taxpayers of France gave you a "freebie" -- that's all.
Also: something is wrong with your story about the kidney patient. There is a WORLD WIDE shortage of organs, especially kidneys, and a 5 month wait is almost unheard of -- most people wait up to 7 years and about 80% die before getting a kidney.
Bottom line any countries' system is better than ours. If the truth be known with more data, even the one winner you gave US would be overturned.
Oh...here is one you forgot, Rwanda vs. US. The winner is Rwanda. It has a $12 affordable, quality, universal health plan for all its' citizens.
Oh...here is one you forgot, Rwanda vs. US. The winner is Rwanda. It has a $12 affordable, quality, universal health plan for all its' citizens.
102
"Announced by Rwandan President Paul Kagame and former U.S. President Bill Clinton in 2012, Human Resources for Health is a seven-year, $150 million collaboration between the U.S. and Rwandan governments and 25 leading U.S. academic institutions."
1
Amazing isn't it gee whiz? A country like Rwanda that was just involved in a genocide that killed millions of people has a better health care system than the US.
I also believe the Bahamas have a universal, affordable plan. When I was on a bus in a tour there recently, the tour guide announced it and was amazed why America doesn't have one. After, he apologized for dissing America. I went over to him afterwards and said, no problem, we deserve it.
Mind boggling....
I also believe the Bahamas have a universal, affordable plan. When I was on a bus in a tour there recently, the tour guide announced it and was amazed why America doesn't have one. After, he apologized for dissing America. I went over to him afterwards and said, no problem, we deserve it.
Mind boggling....
4
paul: I will double-dog dare you to go to Rwanda for your next medical procedure!
You know darn well you would never, ever go there for any medical care whatsoever.
What does it matter if it is $12 a year, when it is WORTHLESS?
You know darn well you would never, ever go there for any medical care whatsoever.
What does it matter if it is $12 a year, when it is WORTHLESS?
1
My reading of this is that you've treated political acceptability - in particular to a bipartisan audience - as a factor, which has diminished the value of socially funded care. Naturally, the UK loses in such a comparison (as does one red in tooth and claw, such as the US) and you end up with Switzerland.
One anecdotal example of the US health system in action: I travelled there last year and forgot to take some medication, which I found I needed. In the US, unlike the UK, the medication is prescription only. So I found someone willing to and qualified to write me a prescription (a receptionist at a certified centre - the receptionist had no medical qualifications and asked me only a couple of questions - "do you know how to use this" and "how much do you want?"). They charged me $50 for the signed note. I took it to Walgreens. They wanted to charge me $1000 a unit. The same drug is available, over the counter, from Boots in the UK at £5 a unit, or £3 a unit if you don't want the commercial brand. Boots is owned by Walgreens. This is nuts.
Similarly, the private insurance system that holds this up is often funded by employers. When I had US employees, we funded their insurance (which they absolutely expected) and applied similar funding to the UK and continental Europe, where available (this was seen as a relatively unusual perk). The US cost for an employee of the same age was about 20x that of the UK. Also nuts.
(more to say but out of space, will add separate comment)
One anecdotal example of the US health system in action: I travelled there last year and forgot to take some medication, which I found I needed. In the US, unlike the UK, the medication is prescription only. So I found someone willing to and qualified to write me a prescription (a receptionist at a certified centre - the receptionist had no medical qualifications and asked me only a couple of questions - "do you know how to use this" and "how much do you want?"). They charged me $50 for the signed note. I took it to Walgreens. They wanted to charge me $1000 a unit. The same drug is available, over the counter, from Boots in the UK at £5 a unit, or £3 a unit if you don't want the commercial brand. Boots is owned by Walgreens. This is nuts.
Similarly, the private insurance system that holds this up is often funded by employers. When I had US employees, we funded their insurance (which they absolutely expected) and applied similar funding to the UK and continental Europe, where available (this was seen as a relatively unusual perk). The US cost for an employee of the same age was about 20x that of the UK. Also nuts.
(more to say but out of space, will add separate comment)
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The other thing I was going to say, on the flipside - in the UK (as in many other countries) parts of the public sector (managerial, IT, operations) can be seen as a second-class career - pay is lower at the low end than the private sector. It can get breathtakingly high at the high end, but the career path attracts less qualified individuals.
As a result, these functions within the NHS are fulfilled by inefficient internal functions and incredibly inefficient, bottom-feeding contractors such as Atos, G4S etc. who hold the system in a vice, providing services procured by nabobs who effectively set their own pay, and who, even in the worst case that they preside over a public scandal, will simply take a golden goodbye and rapidly get the same job somewhere else in the system. The UK has managed some quite spectacular IT procurement disasters, notably in the NHS. It's no coincidence that the UK government remains one of Microsoft's largest customers worldwide (this isn't necessarily to decry MS, it's just a symptom of the UK public sector's allergy to technical innovation).
The US's decentralisation might not be efficient but it is at least effective at implementing functional innovation to the benefit of its "customers".
As a result, these functions within the NHS are fulfilled by inefficient internal functions and incredibly inefficient, bottom-feeding contractors such as Atos, G4S etc. who hold the system in a vice, providing services procured by nabobs who effectively set their own pay, and who, even in the worst case that they preside over a public scandal, will simply take a golden goodbye and rapidly get the same job somewhere else in the system. The UK has managed some quite spectacular IT procurement disasters, notably in the NHS. It's no coincidence that the UK government remains one of Microsoft's largest customers worldwide (this isn't necessarily to decry MS, it's just a symptom of the UK public sector's allergy to technical innovation).
The US's decentralisation might not be efficient but it is at least effective at implementing functional innovation to the benefit of its "customers".
1
The various Conservative governments (all but 14 of the past 38 years) appear to be trying to kill the NHS by attrition, i.e. the common right-wing passive-aggressive trick of deliberately managing it poorly and imposing impossible conditions in order to "prove" that it doesn't work (cf. the U.S. Postal Service).
One wonders how well it would do if managed by a government that actually believed in it.
One wonders how well it would do if managed by a government that actually believed in it.
6
Agree 100% Last year, I received a new prescription and went to Safeway to fill it. I was told the cost would be around $220. I went online and used a 'discount prescription drug service' that Safeway agrees to participate in, which gave me a "voucher" I could use to pay about $45. When I finally ended up at the Safeway pharmacy, they were unaware of this "voucher" system their employer was a party to, but told me they could process (with their magic computer system) a "Safeway discount" that would have me paying about $35.
I had a very similar with Walgreen's 6 months earlier.
I'm going out on a limb and saying that whoever produces this generic prescription--and the reseller Walgreens or Safeway--would have made a decent profit at $35--or they would never agree to that price in the first place. Yet they were willing to have me pay over $200 before I started investigating other options.
These and countless other stories--like Steve Brill's investigation of the infamous 'chargemaster' used by hospitals--show what an absolute mockery it is to even pretend healthcare is something that can be handled by "market" solutions like conservatives/libertarians claim. There is no rational costing system, no transparency to 'customers', and often no 'choices' among providers...and that's assuming a 'rational' actor who most sick/diseased people don't even come close to representing.
I had a very similar with Walgreen's 6 months earlier.
I'm going out on a limb and saying that whoever produces this generic prescription--and the reseller Walgreens or Safeway--would have made a decent profit at $35--or they would never agree to that price in the first place. Yet they were willing to have me pay over $200 before I started investigating other options.
These and countless other stories--like Steve Brill's investigation of the infamous 'chargemaster' used by hospitals--show what an absolute mockery it is to even pretend healthcare is something that can be handled by "market" solutions like conservatives/libertarians claim. There is no rational costing system, no transparency to 'customers', and often no 'choices' among providers...and that's assuming a 'rational' actor who most sick/diseased people don't even come close to representing.
7
I am surprise to see Canada drop out so quickly having worked with and in many of the health care systems you rate. One disadvantage that Canada has in this match-up? The fact that talent can move back and forth so easily across the 49th parallel - it means Canadian health care professionals get paid more closely to US rates (except high end specialists) leading to some of the highest pay rates for GP doctors and nurses in the group. I saw a number of migrations of Canadian professionals to the US when their pay was much lower, and few coming back (although they do). This adds to the cost picture of the Canadian system versus the EU models. As well, Canadians expect more of the types of care they see south of the border, advertised in their magazines and on TV commercials . Except they want it for everyone, which is not the US way. They don't get all of the costly services and medicines the US gets, but that's where the "Canadians go south when they really need it" mantra comes from. Yes, some do. But they could also go to Britain or other cash for care models if the airfare was cheaper.
8
Air fare? Come on! Most Canadians live within 90 miles of the US border. Going to the US for health care IS THE NORM; it's only a short drive away plus you can get in some bargain shopping while you are at it.
Although I have received excellent care from my primary physician and also from specialists here in the US, I was never more impressed than when I was in Spain and saw a physician there. I had become ill and requested the hotel to arrange for me to see a doctor. I received an appointment for the same day. He gave me a thorough exam, spent a long time speaking to me and my husband about my symptoms. He gave me some pills to start immediately and a RX for more. Not only did he give me an almost hour-long examination, but he charged me very little, which I paid then and there. My pharmacy bill was also very low.
8