A comparison of U.S. health care system with 5 other countries

This is from the NY Times. Many of the best systems such as France are not even discussed. Also, insurance premiums are hardly an efficient mechanism for paying for care. As the article notes Britain has none. Some Canadian provinces have premiums but most do not. Some that had premiums have done away with them and simply paid costs out of general tax revenues. If you have premiums you are faced with adopting some mechanism for seeing that the least well off do not need to pay. Of course one has to collect the premiums as well.


Lower Insurance Premiums and Better Care: Un-American Health Delivery
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DiggFacebookMixxYahoo! BuzzPermalinkBy MIKE HALE
Published: April 15, 2008
If your latest battle with your H.M.O. has you pounding your head with frustration, “Sick Around the World” on PBS may spur you to more drastic action, like leaving the United States altogether.

In this “Frontline” report on Tuesday night, the Washington Post reporter T. R. Reid travels to five countries — Britain, Japan, Germany, Taiwan and Switzerland — that manage to provide some form of universal health coverage to their populations. In each nation, he reports, insurance premiums are significantly lower than those in America (in Britain there are none), and the waiting time to see a doctor is either tolerable (in Britain) or nonexistent.

This fast-moving and entertaining hour starts from the premise that the American health care system, with its high costs, multiple gatekeepers and failure to provide insurance for much of the population, is a failure. And Mr. Reid makes the case (in about 10 minutes per country) that other capitalist democracies have not just cheaper and more equally available health care, but also better care over all, with longer life expectancies and lower infant mortality rates. The clinics and hospitals he visits may not be as spacious and well buffed as those in American suburbs, but surveys of these countries’ citizens — the actual consumers of care — show rates of satisfaction that should make American providers blush.

How do they do it? The British, of course, have done it by nationalizing the medical profession, and Mr. Reid, who’s on the lookout for ideas that will work in the United States, admits that this one’s a nonstarter. In the other countries, however, the systems — doctors, hospitals, insurers — are for the most part private, and the difference lies in government regulation that is heavy by current American standards but far short of socialism.

The key factors, Mr. Reid determines, are mandatory coverage (only in Germany are the rich allowed to opt out of the national insurance system), a competitive but nonprofit insurance system and price fixing in the medical industry. One of the greatest savings created by this increased regulation is, counter-intuitively, less bureaucracy: with no combat between insurers and insured, and with no fear on the part of doctors and hospitals that they won’t be paid, these systems have dramatically lower administrative costs than in America.

Nothing is perfect, of course. We see German doctors taking to the streets in mass protests over the low payments they receive. We learn that the Japanese and Taiwanese systems are running at a deficit, which will mean either higher fees or higher taxes. But even if those Asian countries were to make up their deficits immediately, they would still be spending only half as much of their gross domestic product on health care as the United States — and, by all accounts, providing far more to their people than the “safety nets” that our presidential candidates propose as solutions to the American crisis.

One area “Sick Around the World” doesn’t explore is the one that probably makes many Americans — those well above the poverty line, anyway — most nervous about the idea of medical regulation: the availability of the kind of heroic, expensive care we expect when our hearts fail, or cancer strikes. That kind of care is the subject of “The Truth About Cancer,” another PBS health special, on Wednesday night.

In this program the television producer Linda Garmon documents the battles of her husband and several other Boston-area patients against different forms of lethal cancer — mesothelioma, pancreatic cancer, adult leukemia — in a film that is alternately scattered and emotionally wrenching. It’s really about Ms. Garmon’s own process of discovering what’s important, for the patient and the family, after a diagnosis of cancer, and that it’s not always one more round of chemo or the latest experimental drug.

FRONTLINE

Sick Around the World

On most PBS stations on Tuesday night; check local listings.