5 Myths About Health Care Around the World

[Dan J 277]

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

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

1. It's all socialized medicine out there.

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

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

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

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

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

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

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

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

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

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

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

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

4. Cost controls stifle innovation.

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

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

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

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

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

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

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

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

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

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday

http://www.washingtonpost.com/wp-dyn/conte...2101778_pf.html

[one...two...tree 2,762]

I watched T.R. Reid on the Link network the other night talking about Health Care. He's the leading expert on health care systems around the world.

[Mr. Big Dog 10,747]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

[pedroh 21]

'socialized' medicine works in other countries?? no waiiiii

[almaty 19]

'socialized' medicine...first step towards communism.....thank marx

[kaydee457 13]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

You liberals frame everything in the same way when you just can't understand why everyone doesn't see your distoreted point of view, there must be something wrong with us; we are manipulated, etc.

It's the "guns'n religion" stuff straight from the far lefty Obama......So you know what's wrong with us, do you MrBig? We're just not as astute and wordly as person such as yourself?

[Danno 1,228]

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

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

1. It's all socialized medicine out there.

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

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

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

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

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

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

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

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

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

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

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

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

4. Cost controls stifle innovation.

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

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

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

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

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

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

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

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

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

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday

http://www.washingtonpost.com/wp-dyn/conte...2101778_pf.html

Seriously, does anyone actually take this spin as anything but ... spin?

NOt even an attempt at objectivity here.

Bottom line for me: Collectivism is always at odds with Liberty.

[Marina-Del 10]

Well, I agree Danno that the author of this report was clearly biased toward one end...which is not the way to sway people affectively. However, you have to admit that the article makes some good points?

How is it okay that millions are without insurance and that thousands go bankrupt from medical bills every year?

[Mr. Big Dog 10,747]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

The fact of the matter is that there is ample evidence both within the US as well as in other comparable countries that government works better than private for profit enterprise in creating effective and efficient ehalth care systems. Again, Medicare outranks private insurance in service, coverage and cost. The health care systems of comparable countries outrank the US system in effectiveness, efficiency and overall health outcomes. The only item where we rank way on top is cost. Nothing to be proud of.

The evidence that government does a better job of organizing health care is on the table. Your "conclusions" are based on ideology rather than reality.

[Mr. Big Dog 10,747]

Seriously, does anyone actually take this spin as anything but ... spin?

Care to be a bit more specific as to what has been spun?

[Dan J 277]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

You liberals frame everything in the same way when you just can't understand why everyone doesn't see your distoreted point of view, there must be something wrong with us; we are manipulated, etc.

It's the "guns'n religion" stuff straight from the far lefty Obama......So you know what's wrong with us, do you MrBig? We're just not as astute and wordly as person such as yourself?

If you read the article, you would see that there are countries that have a completely private system, that do much better than the US in terms of cost. They are regulated by the government to provide basic health coverage at a certain level, and most can do so while still making some money.

If a company wants to generate more profit, its more likely to raise prices than it is to try to cut costs. Especially when healthcare is so essential to any sort of quality of life, companies can get away with it. People will pay the 10-15% increases every year until they can no longer afford it. The only way to get a company to cut costs is to make it difficult if not impossible to raise prices, which is definitely not happening in the US health insurance market. There is little incentive to do so when people so willingly pay higher prices.

[one...two...tree 2,762]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

You liberals frame everything in the same way when you just can't understand why everyone doesn't see your distoreted point of view, there must be something wrong with us; we are manipulated, etc.

It's the "guns'n religion" stuff straight from the far lefty Obama......So you know what's wrong with us, do you MrBig? We're just not as astute and wordly as person such as yourself?

Every time you flush the toilet, you should be thanking government, you unappreciative government leech. I suggest you disconnect from the grid. Cancel your water, sewage and trash. Build a wall around your house and a helicopter landing pad on your roof since you won't want to be using those public roads. Also, stop using the internet, because all your ranting against government as incapable of doing anything good while relying on government for your daily life makes you out to be one lame-azz hypocrite.

Edited October 27, 2009 by Col. 'Bat' Guano

[kaydee457 13]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

You liberals frame everything in the same way when you just can't understand why everyone doesn't see your distoreted point of view, there must be something wrong with us; we are manipulated, etc.

It's the "guns'n religion" stuff straight from the far lefty Obama......So you know what's wrong with us, do you MrBig? We're just not as astute and wordly as person such as yourself?

Every time you flush the toilet, you should be thanking government, you unappreciative government leech. I suggest you disconnect from the grid. Cancel your water, sewage and trash. Build a wall around your house and a helicopter landing pad on your roof since you won't want to be using those public roads. Also, stop using the internet, because all your ranting against government as incapable of doing anything good while relying on government for your daily life makes you out to be one lame-azz hypocrite.

LOL-

[kaydee457 13]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

The fact of the matter is that there is ample evidence both within the US as well as in other comparable countries that government works better than private for profit enterprise in creating effective and efficient ehalth care systems. Again, Medicare outranks private insurance in service, coverage and cost. The health care systems of comparable countries outrank the US system in effectiveness, efficiency and overall health outcomes. The only item where we rank way on top is cost. Nothing to be proud of.

The evidence that government does a better job of organizing health care is on the table. Your "conclusions" are based on ideology rather than reality.

I'm not taking the bait on this because I know that you can produce stats that back you up and I'm 100% I can find stats that back my contentions up. The real difference in opinion we have are twofold: I have personal experience dealing with the Feds beyond that of the ordinary citizen; and secondly their lackluster performance in managing SS, MEDICARE, MEDICAID, and a whole host of other bureaucracies I can't even remember.......

They are the model of inefficiency if everything they do and there’s plenty of hard evidence to back up that claim!

[one...two...tree 2,762]

Very good summary. Unfortunately, the fact that our health care system is far from the best in the world will fall on deaf ears in this great country of ours. Despite the overwhelming evidence to the contrary, too many Americans have allowed themselves to be manipulated into believing that only the absence of government will produce the best result. It's almost like a religion.

LOL...No, those of us that have dealt with the Government all our adult lives have come to our own conclusions!

The fact of the matter is that there is ample evidence both within the US as well as in other comparable countries that government works better than private for profit enterprise in creating effective and efficient ehalth care systems. Again, Medicare outranks private insurance in service, coverage and cost. The health care systems of comparable countries outrank the US system in effectiveness, efficiency and overall health outcomes. The only item where we rank way on top is cost. Nothing to be proud of.

The evidence that government does a better job of organizing health care is on the table. Your "conclusions" are based on ideology rather than reality.

I'm not taking the bait on this because I know that you can produce stats that back you up and I'm 100% I can find stats that back my contentions up. The real difference in opinion we have are twofold: I have personal experience dealing with the Feds beyond that of the ordinary citizen; and secondly their lackluster performance in managing SS, MEDICARE, MEDICAID, and a whole host of other bureaucracies I can't even remember.......

They are the model of inefficiency if everything they do and there's plenty of hard evidence to back up that claim!

Bureaucracy and inefficiency happens in the private sector and you know it. However, if you want to compare the efficiency of our Social Security to any private insurance, I challenge you to find a comparison. Ranting that government programs like SS and Medicare are inefficient in comparison to private sector entities is nothing but Right Wing propaganda that blowhards such as yourself keep repeating on websites like this because it makes you feel big.