Separating Fact From Fiction in Healthcare
I see that the healthcare debate has taken a completely ugly turn in America and that is unfortunate. So what I want to do is separate fact from fiction in the health care argument and then talk about what I think works and does not work. What I will do is talk about the healthcare systems that I actually witnessed firsthand.
Canada
The whipping child of many American’s on how it is bad socialized healthcare. First let me point out that there is no Canadian health care. It is a provincial matter. So there are provinces with better or worse healthcare. Secondly depending on the province you can get certain things from the private sector. The favourite example is that MRI’s have a huge waiting list. Well that is a pile of crap! If you want an MRI you can get it right away, but you just have to pay for it! If you want it free, well then you have wait until your doctor approves it.
Does the Canadian system work? Sure it works! Does it help the general populace? Sure it does! Are there issues? Heck yes!
I wish to add a recent example (a couple of days ago) where a friend of ours fell off the roof and smashed his foot. He then was sent to the local hospital in Jolliette. But because there was no surgeon available he was flown to a premier hospital in Montreal that had a surgeon. My point is that he got the attention he needed right away.
America
An expensive health care system if you can afford it. Sure you get a doctor, sure you get attention, but it all boils down to whether or not you have the money to afford the plan to get the care you want. If you are not able to get the plan then you have a couple of problems.
What gets me about the American system is that they have the ability to cherry pick people and what they cover. This in my opinion is counter productive and leads to more problems than solutions.
Germany
A mixture of public and private probably similar to what America is pursuing right now. The German system has its issues and one of them is that the public health care client is getting short changed by the private system. You can get the immediate attention you want so long as you are willing to pay for it. In the German system there exists the same clauses where if you have heart problems you will not get private insurance for your heart.
Austria
A public health care system that seems to work, though I did not stay long enough to completely understand it.
France
A public health care system that REALLY works. The French health care system is great! Though the catch is that it costs 11% of your pay cheque. And that 11% is across the board for rich or poor. Though this system has immediate attention, you get the health care you want and you get the attention of your doctor. I actually like this system and think it would be a better role model than say the Canadian health care system.
But oh, talking about France to Americans would be a slap in the face! Well that is an American problem, no? My wife and I would have no problem retiring to France and paying the 11% since we know that it is a health care system that works.
Switzerland
This is an interesting health care system where it is completely private, but controlled by the public government. Think of it as Canadian with private. This system is actually not too bad. The costs are not that bad (eg the monthly costs) and the health care providers are not allowed to cherry pick. I would say that this system is actually pretty good, but it is overpriced for what you get. Though the Swiss people don’t help that by voting “crack pot witch doctor” medicine into the base system.
What I like about the Swiss system is that you have choice and you can get additional perks if you are willing to pay for it. Though there is no cherry picking allowed and no insurance company can refuse to cover you. I actually like this system because people get the urgent care they need, but can pay if they want more frills.
United Kingdom
This is a public health care system like Canada, except with the option of getting extended insurance to cover additional items. It is not like Germany where private competes against public, but one where private extends public. Not that bad of a system actually.
My Thoughts
I have gone through quite a few systems and have relatives (Ecuador, Russia) that have gone through other types of systems. The reality is that health care costs! It really does not matter what type of health care system you have whether private or public, it costs.
In the French system where the costs are distributed among the people and the same percentage is paid by both rich and poor you get a great health care system. But the key thing to remember is that the costs are distributed.
In the case of places like Canada, and the United Kingdom where health care is public the real problem here is underfunding. It is not a problem that the public health care system is bad, but the reality that it is underfunded. Canadian’s and British don’t want to pay for a quality health care system, unlike the French who are willing to pay. For example Quebec has a pretty good healthcare system. But guess what Quebec has the highest tax rate in Canada. My point stands that healthcare costs!
I do believe that the worst healthcare systems are the German, and American. Even though the German system has public it is underfunded and because it allows the private system to cherry pick you get real problems.
I am not a believer in a free market approach to healthcare. I do believe in the free market in general, but healthcare has the problem of having to deal with what we call humanity. When we are confronted with humanity we become irrational and we do things that many would not consider logical. But I feel that is ok since we are humans.
Let me add a personal angle. My mother is a breast cancer survivor. Fifty years ago she would not have been a healthcare problem because she would be DEAD! But now she is a drag on our healthcare system. And frankly I like it that way! Yes she sucks up healthcare dollars with her constant checkups and constant monitoring, but that is the society that I chose! As mothers or relatives are important to most people I cannot say my mother survives and yours doesn’t due to the fact that I might have the money to pay for it and you don’t.
Thus my only solution is to accept a regulated health care system. Does that mean everything has to be public? Can there be private extensions? Sure why not. But what I don’t accept is the cherry picking and control exerted by insurance companies.
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@Christian,
“But now she is a drag on our healthcare system. And frankly I like it that way! Yes she sucks up healthcare dollars with her constant checkups and constant monitoring, but that is the society that I chose! ”
you obviously believe healthcare is a natural right- thus we are left with a stalemate. FWIW, I think you stance is COMPLETELY illogical from a resource utilization standpoint.
Where do you draw the line? If your mom needed a $2mm procedure and was 84, would you expect the public to pay for it? How many of these procedures can the public afford? You solution is to let the government decide…
Booooooo!
Yeah I believe healthcare is a right in our society! Now with respect to resource utilitization, what did I say about the issue of healthcare? It is illogical because it approaches humanity.
You see we can all talk about “resource utilitization” and what’s best for society, until it is your wife, your mother, your father or your child lying in the bed. At that point using the argument of resource utilization has absolutely no RELEVANCE!
I have experienced this all too often that people will talk the talk, but not walk the walk. Because once we get to the point of dying or seeing somebody die we become irrational. We want to live and survive and I have yet to encounter somebody who would say otherwise.
Thus if we want to live we want the best care that we can get, even if it costs 2 million on our 84 year old mother. And I know other people would say the same. Of course this is irrational from a resource utilization perspective, but that is what humanity is.
Let me twist this argument completely around. Take the example of our friend who broke and mashed his foot. From a free market perspective and insurance perspective it would be best to amputate his foot. For the surgery on his foot is oodles more expensive.
Do you find my argument crazy? Well you should not because you are talking resource utilization here and amputation is better. The problem is that society does not think this is better. Society expects his foot to be saved even though it makes no sense whatsoever.
Thus if healthcare involves making decisions that are not logical how do you handle what each member of our society gets? Answer government or some agency.
I am not saying government should pay for it, in fact in the Swiss system government does not pay for it. I am saying government has a role to play in keeping the playing field level and ensuring that everybody pays their fair due whether to an insurance company or the government.
Christian,
No I don’t find your argument crazy. If your friend wants to keep his foot, then he needs to pay for the procedure to save his foot. If he can’t afford it, then that’s tough shit. I’ll support your friends efforts to raise money via donations from friends family even the public. What I will NOT support is the government putting a gun to my head and forcing ME to fork over my saved resources to save your friend’s foot.
Once healthcare is nationalized, government and special interest will be controlling what we do, what we eat, how we live life. That is NOT a world I want to live in.
Furthermore, your argument is completely emotional. I know you understand this, but still… emotion has NOTHING to do with what is optimal.
>Furthermore, your argument is completely emotional. I know you understand this, but still… emotion has NOTHING to do with what is optimal.
But this is why your argument will not win the day. I trade and invest the markets and if there is one thing that you need to respect it is psychology and its emotion. What I avoid is having emotion control my behavior. BUT I make damm sure that I understand the emotion that is involved in the situation. Emotions and the madness of crowds are a freight train that you cannot stop.
Healthcare is a freight train that you cannot stop. If I were in your boots I would argue that the government play a central role, but not provide healthcare itself. Namely that they adopt a Swiss style healthcare. Such a system is completely regulated except that the entire system is private and that EVERYBODY has to have health care.
>Once healthcare is nationalized, government and special interest will be controlling what we do, what we eat, how we live life. That is NOT a world I want to live in.
That is being a bit paranoid… I have yet to live in a country where this is the case.
Christian….
I agree…I alone will not be able to stop it. That doesn’t make it correct. Populist pandering may win elections, but it does not improve NOR sustain quality of life.
If everyone in the world wants $5 million dollars. Why doesn’t the government just print it up? Government this, Government that.
Not yet any ways… its a logical assumption though. What happens after nationalized healthcare “rationing” begins to breakdown? Would it not be safe to assume that things like fast food, sodas, tobacco would have the shit taxed out of them? And is that not in and of itself the same effect as government controlling what you put in your body?
wake up…you’ve been living in fantasy land.
Let’s do the math here people. Someone working for $10.00/hour at McDonald’s full-time makes $20,800.00/year. If the government taxes 11%A that ends up being $2,288.00/year or $190.67/month. For a single person, you can go to Blue Cross & Blue Shield and receive $5 million worth of coverage and 10% copay up to the $2,000.00/yr cap for about $130.00/month. For someone under the age of 24, they can receive young blue for under $50.00/month. In order to have the government provide less coverage you are costing that person $60.00/month more or $720.00/yr. That is a whole house payment.
Another thing that you failed to outline is, that emergency rooms have policies that cause for a no more than a wait time of so many hours. Emergency rooms where being backed up and in order to not be fined from the government they started double and triple stacking ambulances outside the emergency room because the time limit did not start until they reached the doors of the hospital. People where dieing because there were a shortage of ambulances.
Also, there is something to be said that 250 million Americans have health insurance with only 45.7 million not having it. Less than 19% of Americans do not have health insurance; however, you cannot make a proper analysis of our health care system until you review the underlying numbers for the 45.7 million Americans who do not have health care.
1. 6.4 million are the Medicaid undercount, meaning they are either on Medicaid or S-Chip but say they are uninsured, and another 4.3 million are eligible, yet have not signed up for, Medicaid or S-Chi
2. Another 9.3 million are non-citizens.
3. 10.1 million have incomes more than three times the poverty level, and could afford to purchase insurance, but choose not to for various reasons
4. remaining 15.6 million uninsured, 5 million are adults without children between ages 18 and 34
I’m sorry but as an American it is not might right to force people to have health care and it sure isn’t my need to fund non citizens with health care. Our founding fathers came to America because of the idea of single rule and freedoms. It was to create a government that provided the citizens of the country to make their own choices on religion, business, family, etc. That is what makes us the largest economy and power in the world. Universal health care deifies what this great country was based on. It is limiting our freedoms in America. That is why we have some of the highest rate of immigration and people are jumping the boarders illegal to get in here.
We have the best health care system in the world when it comes to taking care of patients and hospitals are unable to cherry pick patients. Hospitals are unable to deny health care based on financial standing. I lost my mother from Cancer and my Grand Mother from Cancer, and my best friend from Cancer. You know what while I may have lost them, they all had the best damn medial treatment that money could by. Health care is not a right its a privilege. As I have shown above, you can work full0time at McDonalds and have it. When 10.1 million Americans make over $90k per year and do not want health care because they can afford it, that says something here.
Born in the U.S.A And proud to have FREEDOM.
Zachary:
You are getting your “freedoms” mixed up with rhetoric.
I live in a country and soon will be a citizen of a country that is staunchly libertarian called Switzerland. While the US was debating on democracy, freedoms, Switzerland already had people’s rights and freedoms. So please tone down your “nationalistic” arguments since other people on this planet might actually have those freedoms and then some!
I can also argue that Switzerland has one the best health care systems in the world and it is 100% private! Additionally it is cheaper than yours and we have some of the biggest names in drugs doing research in “my” country.
http://www.dallasnews.com/s/dws/bus/stories/DN-swisshealth_07bus.ART0.State.Edition2.21730ee.html
“People in Switzerland realize what these costs do to American business, and they don’t want to add to the anti-competitive burden of Swiss businesses in the global economy,” said Dr. Gutzwiller.
“Also, people do not want employers to get so much into their private life and lifestyle.”
The Swiss think the quality of their medical care is among the best in the world. They spend more of their national income on health care, 11.5 percent, than anyone except Americans, who spend 16 percent.
The Swiss have the freedom to see any doctor in their canton, and they don’t have long waits. And Swiss health care providers have much less paperwork than their U.S. counterparts.
In 2003, Switzerland spent an average of $3,781 per person on health care. The United States spent $5,635 per person, according to an October report of the Organization for Economic Cooperation and Development.
———
The Swiss system is pragmatic and decided by the people (direct democracy here). And the Swiss people know that everybody has to get coverage so that the system does not collapse due to the burden of a few.
In fact what you really should be thinking about is, “why is Switzerland so much cheaper?”
The differences?
1) Everybody has to have coverage
2) Insurance companies have to provide basic coverage without risk being applied
These difference make a world of difference because it is the base costs that can spiral out of control. A waiting ambulance or an emergency room full of people waiting at the last moment is an expensive proposition!
I stand by my conclusions. Does the health care system have to be public? No! Does the health care have to be regulated? Absolutely, at least for the essentials.
Christian…
this is ridiculously disingenuous.
Bill:
Disingenuous? Huh…
Seriously I am saying that the fact that everybody has to have coverage and that health insurance have to provide basic coverage without risk makes things much much more efficient.
The core problem of health care is that it costs. If I was a health care provider I would not want people with problems on my balance books. Thus I will go to great extents to make sure that they are not on my balance books. These games cost money, time and efficiency.
If the government was to say, “hey you have to provide health insurance to anybody, at least the basics” then I would say sure, ok, but I need as many people to pay for health insurance as possible.
In other words I need my costs covered and the only way I can have that happen is if everybody and I mean everybody HAS TO HAVE health insurance. That way I know what my potential pool size is and how much potential money I can make to cover the basic costs.
In other words what I have done with this basic calculation is that I as a private health insurance company can determine what my costs are, and what my income streams are. There are very little unknowns!
And because of this situation I know that other health insurance providers are in the exact same boat. I don’t have to compete on the basis that some are cherry picking my clients away while I get stuck with those that have many problems. The playing field is completely level….
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