Thursday, January 28, 2010

More on health care debate from T. R. Reid (Part 3)

The following from T. R. Reid's important book, The Healing of America:  A Global Quest for Better, Cheaper, and Fairer Health Care:

Even if we found good ideas in other countries, could the United States find the political will at home to use them? One basic political truth about American health care is that our system is strongly resistant to change. The vested interests that are doing well in the health business now – insurance companies, hospital chains, pharmaceutical companies – have blocked significant restructuring of our system (p. 22).

All the developed countries I looked at provide health coverage for every resident, old or young, rich or poor. This is the underlying moral principle of the health care system in every rich country – every one, that is, except the United States (p. 23).

Every country on earth faces difficult problems in providing medical care to its people. Nobody’s system is perfect. There are health care horror stories in every wealthy country – and they’re true… But for all of their problems, the other industrialized countries tend to do better than the United States on basic measures of health system performance: coverage, quality, cost control, choice. What are we doing wrong? (pp. 26-27).

When it comes to the essential task of providing health care for people, the mighty USA is a fourth-rate power (p. 28).

How many people go bankrupt because of medical bills? In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United States, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.

For all the money America spends on health care, our health outcomes are worse on many basic measures than those in countries that spend much less (p. 31).

The United States is the only developed country that relies on profit-making health insurance companies to pay for essential and elective care. . .

All the other developed countries have decided that basic health insurance must be a nonprofit operation. In those countries, the insurance plans – sometimes run by government, sometimes private entities – exist only to pay people’s medical bills, not to provide dividends for investors… The U.S. private insurance industry has the highest administrative costs of any health care payer in the world (pp. 36-37).

If insurance companies have to cover everybody who applies, they need to have everybody in the insurance pool to cover the costs. All other developed countries require both “guaranteed issue” and the “individual mandate.” The United States has neither (p. 38).


c hand said...

What deductible? The higher the better...say $10,000

TwoCents said...

High deductibles and some rational rationing are the only way to hold down health care costs in the long run.

High deductibles give people an incentive to carefully manage day-to day health care costs if they're coming out of pocket.

Some form of "rationing" is required in an era when many treatments with a questionable payoff exceed $100K. From a public policy standpoint, it simply makes no sense to spend $100K to give a dying person an extra 30 miserable days of life (meaning in quality of life). Sorry, but it has to be said.

Anonymous said...

two cents - sorry, but the government has no business in determining what and how much health care i get. I pay taxes at the highest rate - allowing others who are less fortunate to receive many benefits - so for the government, you or anyone else making such decisions for me is... well... idiotic and why i have such new-found distain for people of your ilk.

Anonymous said...

That's great, Anon. 5:21. Disdain always helps a discussion.

Actually, what I had in mind was reasonable limits on whatever health care the gov't offers, primarily to those who otherwise cannot afford health insurance. We continually engage in all-or-nothing thinking about health care. If we placed reasonable limits on health care for those who use whatever gov't fall-back we put in place, it would go a long way to keeping the cost down and making it affordable. Half a loaf really is better than no loaf.

I don't care what choices you make if you pay for them (either through high premiums or out of pocket.)